Abstract PO-009: Assessment of geographic and racial/ethnic variables in tobacco use among cancer patients in a widely dispersed academic-led cancer care network
Authors: Ashing Kimlin Tam , Presant Cary A. , Yeung Sophia , Macalintal Jonjon , Tiep Brian , Argelia Sandoval , Raz Dan , Salgia Ravi , Erhunmwunsee Loretta , Amini Arya , Merla Amar , Graves Heather , Rosen Steven 
Published: January 2022

Abstract
Background: Tobacco use is among the most important factors in cancer patient survival. In order to appropriately prioritize resource allocation, we studied the frequency of tobacco use among cancer patients and racial/ethnic minorities in a widely dispersed academic-led cancer care network. Methods: City of Hope (COH) has an academic center in Duarte CA and has 36 community cancer treatment sites across Los Angeles, Riverside, San Bernardino, Orange and Ventura counties. A tobacco use control program was established across multiple departments. A tobacco use screen was developed for every cancer patient and followed by a more detailed tobacco use survey. Self reported racial/ethnic identity and socioeconomic data were collected. A survey of clinicians was performed to determine their attitudes and knowledge about tobacco use, and tobacco cessation treatments. Results: Completion of the tobacco use screen was 96.05%. Data indicated geographically different tobacco use rates at the academic medical center and community sites ranging from 2.75% to 10.81% with an average of 5.87%. The average use was 6.66% in community sites versus only 3.84% in the academic tertiary care center. Highest use was in Antelope Valley (AV), a site with high levels of poverty, chronic disease burden and concentration of dedicated tobacco retail shops. The AV tobacco use rate was 10.81%. Of smokers in AV, 17.30% were African-American, 14.60% were Hispanic, 1.8% were Asian-Pacific Islander, and 40.44% were non-Hispanic white. Tobacco use was highest among communities with the greatest social determinants of health (SDOH) burden and Black population density. 85.96% of clinicians agreed that tobacco cessation should be a standard part of cancer treatment, and 94.74% of clinicians agreed that current smoking and/or tobacco use negatively impact patient outcomes. Patient resistance to cessation advice and treatment as well as lack of proper support were described as the greatest barriers to smoking cessation. There was an association between physician attitude and tobacco use rate which was greater in community sites compared to the academic center. In the highest tobacco use center AV, compared to the academic center, there was perceived greater need for resource allocation to control tobacco use, and this was associated with a higher proportion of minority patients. Conclusions: There are racial, ethnic, SDOH and geographic variations in tobacco use. Allocation of cancer center resources must be based on metrics of patient tobacco use and community factors. Therefore, strategies to reduce tobacco use and cessation must include cultural, linguistic, and community-responsive approaches. Therefore, clinicians, cessation specialists, community advocates and policy makers must coordinate to reduce tobacco exposure and tobacco use disparities. A network-wide tobacco control program coordinated among multiple specialties is needed and elements of such a program at COH will be described as a model for implementation in other institutions.
Citation Format: Kimlin Tam Ashing, Cary A. Presant, Sophia Yeung, Jonjon Macalintal, Brian Tiep, Sandoval Argelia, Dan Raz, Ravi Salgia, Loretta Erhunmwunsee, Arya Amini, Amar Merla, Heather Graves, Steven Rosen. Assessment of geographic and racial/ethnic variables in tobacco use among cancer patients in a widely dispersed academic-led cancer care network [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-009.