Ruth C. Carlos

Supplementary Table S1 shows AUDIT-C improvement at 3 and 6 months by treatment and covariates, adjusted for baseline AUDIT-C.

Background: Alcohol and tobacco use are known carcinogens. Treating alcohol and tobacco co-use can improve treatment and survivorship outcomes among patients diagnosed with cancer. Methods: We conducted a post hoc analysis of ECOG-ACRIN EAQ171CD trial participants within the National Cancer Institute (NCI) Community Oncology Research Program (NCORP), examining changes in alcohol use among adults receiving the virtual sustained treatment (VST) for tobacco use intervention versus enhanced usual care (EUC; Quitline referral). Multivariable logistic regression assessed changes in alcohol use disorder (AUD) risk at 3 and 6 months using the Alcohol Use Disorders Identification Test Concise (AUDIT-C). Results: At baseline, participants (N = 305) were classified as having no risk (31%), low/minimal risk (38%), moderate risk (23%), or high risk (8%) for AUD. The mean age was 55.6 years, participants smoked for an average of 33 years, and 18% had alcohol-associated tumors. Participants randomized to EUC were more likely to shift to a lower alcohol risk category than those in the VST arm at 3 months (39% vs. 27%) and 6 months (33% vs. 27%). There was no significant difference in the odds of shifting to a lower risk category for VST versus EUC at 3 months [adjusted odds ratio (OR), 0.56; 95% confidence interval (CI), 0.26–1.18; P = 0.125] or at 6 months (adjusted OR, 0.57; 95% CI, 0.25–1.28; P = 0.172). Conclusions: Patients diagnosed with cancer and engaging in alcohol and tobacco co-use can achieve reductions in alcohol use and risk. Impact: Integrating tailored, co-use–focused strategies into cessation programs may improve changes in modifiable risk behaviors.

PURPOSE: Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet tobacco treatment has not been integrated into community oncology settings. We conducted a trial of a virtual sustained tobacco treatment intervention across community oncology settings nationwide. METHODS: This randomized controlled trial compared the effectiveness of sustained telehealth counseling plus medication (virtual sustained treatment [VST]) to referral to the National Cancer Institute (NCI) quitline (enhanced usual care [EUC]) in assisting patients recently diagnosed with cancer to quit smoking. The VST group received up to 11 synchronous telehealth sessions (four weekly, four biweekly, three monthly) of motivational counseling and up to 12 weeks of free nicotine replacement therapy (NRT). RESULTS: From August 2019 to December 2022, 306 English- and Spanish-speaking patients were randomly assigned from 37 NCI Community Oncology Research Program community sites. Participants were 70.9% female; 86.3% was White; the median age was 57 years; and 45.4% had non–smoking-related tumors. A total of 221 of 302 (73.2%) smoked within 30 minutes of waking. Six-month, 7-day point abstinence rates were 28.4% (42 of 148) in the VST group versus 14.7% (21 of 143) in the EUC group; there were no significant treatment moderators. A total of 80.8% (126 of 156) of VST participants engaged in counseling, and 85.7% (108 of 126) were dispensed NRT. Participants who completed >8 sessions versus P = .005. VST participants were almost four times more likely to report guideline-concordant smoking cessation medication use. Continuous abstinence and significant reduction rates at 6 months were higher in the VST group. The incremental cost per quit was $7,724 in US dollars. CONCLUSION: Among recently diagnosed patients, sustained remotely delivered telehealth counseling and free NRT were well utilized and nearly doubled 6-month quit rates compared with EUC. Findings support the benefit of adopting sustained tobacco treatment within community oncology care settings nationwide.

PURPOSE: Systematic integration of tobacco cessation treatment within cancer centers is needed to improve smoking cessation outcomes among cancer patients and survivors. The current study characterizes baseline rates of tobacco use, use of cessation support, and changes in tobacco use over time among 756 participants diagnosed with cancer and enrolled in 9 ECOG-ACRIN Cancer Research Group trials. MATERIALS AND METHODS: Participants completed surveys at trial enrollment and at 3- and 6-month follow-ups. Descriptive statistics were used to characterize patient characteristics and selected items from the Cancer Patient Tobacco Use Questionnaire (C-TUQ). Generalized estimating equations were used to examine the time point effect on tobacco product use. RESULTS: At baseline, 11% of participants (n = 740) currently smoked cigarettes. Among participants with data available at all time points (n = 443), prevalence of current smoking was stable over time, with 7.2% of participants (n = 32) reporting current smoking at baseline, 7.0% (n = 31) at the 3-month follow-up assessment, and 6.8% (n = 30) at the 6-month follow-up assessment. Most participants (n = 77/104) who smoked cigarettes within the year prior to their cancer diagnosis continued smoking after their diagnosis, and during (n = 44/72) and following completion (n = 30/46) of their treatment. Sixty-two percent of participants (n = 81) who were currently smoking at baseline reported using smoking cessation medication and 32.1% reported use of nonpharmacologic smoking cessation support since their cancer diagnosis. In longitudinal analyses, the odds of using cigarettes since their cancer diagnosis, 3-month follow-up, and 6-month follow-up was higher than the odds of using cigarettes for the past 30 days at baseline (odds ratio [OR] = 1.97, OR = 1.62, and OR = 1.50, respectively; all p s < .01). CONCLUSION: Smoking persists over time among patients with cancer enrolled in therapeutic cancer trials. Findings highlight the importance of increasing access to integrated and longitudinal smoking cessation support.

A higher incidence of triple-negative breast cancer (TNBC) and worse social determinants of health both contribute to racial survival disparities among Black women diagnosed with breast cancer. A post hoc analysis of the ECOG-ACRIN EA1131 study (adjuvant platinum v capecitabine in stage II-III TNBC with residual disease after neoadjuvant chemotherapy) evaluated racial disparities in disease-free survival (DFS) and overall survival (OS) among Black and White patients. Of the 415 patients enrolled in EA1131, 376 were included in this analysis (308 White [82%] and 68 Black [18%]). Common characteristics included basal-subtype TNBC (77%), grade 3 disease (71%), residual stage II disease (49%), private insurance (70%), and a BMI ≥30 (49%). There were no racial differences in grade and clinical or pathologic stage. Black patients were more likely to have basal-subtype TNBC (89% v 75%; P = .009), a BMI ≥30 (62% v 46%; P = .026), to reside within the lowest neighborhood socioeconomic index quartile (39% v 22%; P = .008), and have Medicaid (32% v 13%; P < .001) compared with White patients. Despite these differences, there were no significant differences in DFS or OS by race (hazard ratio [HR], 0.99 [95% CI, 0.62 to 1.57] and HR, 0.60 [95% CI, 0.32 to 1.12], respectively) among Black and White patients.

Supplemental Table 1 shows cancer types, patient accrual and survey completion rates for parent trials

Supplemental Table 2 shows associations of baseline continuous participant characteristics with past 30-day tobacco product use

PURPOSE: Financial toxicity is an important issue in cancer that affects quality of life and treatment adherence. Screening can identify patients at risk but consensus on appropriate timing or methods is lacking. METHODS: We sent an anonymous survey to e-mail subscribers of a nationwide breast cancer–specific philanthropic organization in July 2023 asking about financial toxicity screening preferences. Frequencies, percentages, and medians were calculated for categorical and continuous variables. RESULTS: Of 5,774 potential participants, 738 respondents with a confirmed cancer diagnosis participated (12.7% response rate). Participants were 93% female (n = 690), had a median age of 50 years (IQR, 44-57), were 57% non-Hispanic White (n = 418), 20% Black/African-American (n = 149), 9.2% Hispanic (n = 68). 93% confirmed a breast cancer diagnosis (n = 689), and 54% were currently undergoing treatment (n = 400). Most indicated not being asked about financial stressors by (58%, n = 425) and not receiving assistance from their care team (68%, n = 498). Most preferred for providers to reach out regarding financial needs (83%, n = 615). Most wished for these discussions to take place early (when first diagnosed [45%, n = 334] or when treatment selected [37%, n = 275]) and to be asked frequently (each appointment [42%, n = 312] or once per month [36%, n = 268]). Participants felt most comfortable discussing financial needs with a social worker or patient/financial navigator (92%, n = 679), in person (75%, n = 553), or via telephone (65%, n = 479). CONCLUSION: Patients in this sample primarily consisting of women with breast cancer desired financial screening to occur early, often, and to be initiated by their providers. Patient preferences can inform optimal implementation of financial toxicity screening practices. Continued work refining best practices for financial toxicity screening should incorporate these patient preferences.

PURPOSE: Health-related social needs (HRSNs) are associated with adverse cancer health outcomes. We assessed the processes for screening and responding to both HRSNs and financial distress and described the methods used across National Cancer Institute Community Oncology Research Program (NCORP) practices. METHODS: The NCORP 2022 Landscape Assessment survey focused on services to screen for and respond to HRSNs and financial distress within a national network of community oncology practices. We calculated the proportions of oncology practices that screened for and responded to HRSNs and financial distress, separately, and described the staff, tools, and methods used for each process. Multivariable logistic regression models estimated the associations between oncology practice characteristics and screening for HRSNs and financial distress. RESULTS: The majority of community oncology practices reported screening for HRSNs (79%), and of those, most inquired about transportation (96%), family and social support (93%), housing (80%), and food security (80%). Most oncology practices reported screening for financial distress (78%). Social worker evaluation was the most common method used to screen for both HRSNs (77%) and financial distress (65%). Most oncology practices reported social work referral as the method for responding to HRSNs (89%) and financial distress (96%). Oncology practice characteristics such as having a survivorship clinic and geographic region were associated with screening for HRSNs and financial distress. CONCLUSION: Research is needed to understand the impact of different HRSN screening and referral approaches on care delivery, clinic costs, care quality, and health outcomes of patients with cancer. These efforts are critical to generate evidence to inform best practices, clinical guidelines, and novel interventions aimed to improve cancer health equity.