Rachel L. Rosen

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.

Introduction Low engagement with tobacco treatment by Black and/or Hispanic adults with cancer who smoke may perpetuate health disparities. The current secondary analysis of a tobacco treatment trial aimed to describe the racial and ethnic characteristics of Black and/or Hispanic cancer patients and to examine the association between these characteristics and treatment outcomes. Method Eligibility criteria were: 18 + years old, newly diagnosed with cancer, smoked ≥ 1 cigarette in the past month, and spoke English or Spanish. Participants who self-identified as Black and/or Hispanic (N = 41), or White (N = 255) received (1) four telephone counseling sessions and information about smoking cessation medication or (2) eight telephone counseling sessions and 3 monthly booster sessions plus 12 weeks of free smoking cessation medication. We examined sociodemographic characteristics, smoking history, and cultural characteristics (e.g., racial/ethnic identity, language, familism, religiosity) at baseline and smoking abstinence at 3- and 6-month follow-ups. Results Black and/or Hispanic patients smoked fewer cigarettes per day (10.5 vs. 14.7 cigarettes per day, p = .03) and reported higher levels of baseline quitting self-efficacy compared to White patients (6.5 vs. 5.3, p = .006). Black and/or Hispanic patients had similar treatment engagement, protocol adherence, and biochemically confirmed smoking abstinence at 3- and 6-month follow-ups compared to White non-Hispanic patients, controlling for the treatment group. Discussion Findings suggest that virtual tobacco treatment was accessible and effective for Black and/or Hispanic cancer patients. Tailored treatment may support greater benefits from tobacco treatment among Black and/or Hispanic patients who experience a greater health burden associated with smoking.

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

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