Abstract PO-011: Use of clinician and nurse tobacco cessation champions to implement a tobacco control program in a geographically disseminated academic center-led clinical network analyzed by patient racial/ethnic group
Authors: Presant Cary A. , Ashing Kimlin Tam , Yeung Sophia , Macalintal Jonjon , Tiep Brian , Sandoval Argelia , Raz Dan , Salgia Ravi , Erhunmwunsee Loretta , Amini Arya , Merla Amar , Graves Heather , Pathak Ranjan , Dingal Shaira , Tan TingTing , Tarkeshian Kelly , Nikolaenko Liana , Burns Kathleen , Sampath Sagus , Laksana Beverly , Rosen Steven 
Published: January 2022

Abstract
Background: City of Hope (COH) is an NCCN academic cancer center in Duarte CA and delivers care in 36 geographically dispersed community sites in Los Angeles, Riverside, San Bernardino, Orange and Ventura counties. We implemented a multi-departmental tobacco use control program (TUCP) (J Clin Med 2020; 1820). In order to facilitate implementation of the TUCP, we developed a multi-level multi-departmental program of clinician/nurse tobacco cessation champions using implementation science principles. Methods: A TUCP centered in Population Science included representatives of all clinical specialties. Cancer center leadership was engaged for resource allocation, and monthly staff communications (Moonshot Shout-outs). Tobacco-using patients were referred for tobacco cessation. To incentivize and promote cessation referrals and patient participation, TUCP worked with physician leaders and nurse leaders to name a clinician and nurse in each academic center clinic and each community site as champions. Results of this program were evaluated by tobacco use assessments and clinician attitude surveys. Results: Among the 36 COH sites and the Duarte academic center, 6 sites were selected for pilot implementation of the champion program. Champions (physicians, advanced practice providers, and nurses in multiple oncology specialties) were appointed and received structured training. Champions were tasked to promote cessation referrals by clinicians and staff, provide support for any problems, meet with TUCP leaders, report barriers to effective cessation implementation, and provide assistance in prescribing tobacco control medications. Tobacco use screening was nearly universal (96%), and showed 5.87% current use overall. Among patients who were smokers, 7.92% were African American, 17.61% were Hispanic, 5.18% were Asian/Pacific Islanders, and 44.09% were non-Hispanic white. Current tobacco use was more prevalent in the community sites than in the academic center and more prevalent in minority patients in community sites. Clinician attitude surveys at the academic center versus community sites revealed similar importance of tobacco cessation, feeling that continued smoking adversely impacted treatment outcomes, referral of patients for cessation, and need for increased training in tobacco control and cessation. Clinicians at the community site with the highest rate of tobacco use and greatest percent of non-white patients, Antelope Valley, expressed the highest need for training into availability of tobacco control services and program support. Conclusions: Tobacco use is widely perceived by clinicians as an important component of cancer treatment, but requires increased resource allocation and leadership, especially at sites with higher tobacco use and greater percentage of racial/ethnic minorities, and worse social determinants of health. Among resources important for tobacco control, multi-level champions (e.g. physicians, nurses, and advanced practice providers) can help promote and implement a TUCP in both academic centers and community sites.
Citation Format: Cary A. Presant, Kimlin Tam Ashing, Sophia Yeung, Jonjon Macalintal, Brian Tiep, Argelia Sandoval, Dan Raz, Ravi Salgia, Loretta Erhunmwunsee, Arya Amini, Amar Merla, Heather Graves, Ranjan Pathak, Shaira Dingal, TingTing Tan, Kelly Tarkeshian, Liana Nikolaenko, Kathleen Burns, Sagus Sampath, Beverly Laksana, Steven Rosen. Use of clinician and nurse tobacco cessation champions to implement a tobacco control program in a geographically disseminated academic center-led clinical network analyzed by patient racial/ethnic group [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-011.