||5R01CA214427-03 Interpret this number
||Massachusetts General Hospital
||Implementing a Virtual Tobacco Treatment in Community Oncology Practices
There are over 15.5 million cancer survivors in the U.S.; survival rates are increasing, but
unfortunately 10-30% of cancer patients are current smokers at the time of diagnosis.
Surgeon General's report concluded that there is sufficient evidence ) linking smoking to
adverse health outcomes in cancer patients and b) that quitting smoking improves cancer
prognosis. Accordingly, the National Comprehensive Cancer Network published its first smoking
cessation guidelines for patients with cancer in 2015.
Most cancer patients do not receive
tobacco cessation support and, specifically, evidence-based tobacco treatment guidelines have
not been implemented in community cancer settings where the vast majority of cancer patients
receive care. The investigative team developed and tested the integration of an evidence based
intensive tobacco treatment (IT), delivered in-person and via phone in English and Spanish, at
two comprehensive cancer centers. Using innovative live videoconferencing technology
), we propose a virtual implementation of the IT in
community sites affiliated with the newly established ECOG-ACRIN NCI Community Oncology
(delivered via computer
or mobile device
Research Program (NCORP). We will use a Hybrid Type 1 effectiveness-implementation trial
design to examine the effectiveness (7-day cotinine confirmed point-prevalence abstinence at 6
months) of two delivery approaches. We will randomize 224 cancer patients who are current
smokers to either the virtual intensive tobacco treatment (VIT) or Enhanced Usual Care (EUC;
and site-specific usual care
). The VIT consists of extended motivational
counseling, delivered by a centralized tobacco coach, plus 12 weeks of combination nicotine
replacement therapy (patch plus lozenge).
Secondary aims will identify patient and NCORP
sites characteristics associated with VIT effectiveness and implementation, guided by Proctor's'
implementation research outcome recommendations and the Consolidated Framework for
Implementation Research (CFIR). Implementation will be facilitated through
interviews (n=40), biannual meetings with NCORP site PIs and staff,
PI/clinicians/staff surveys (n=100), and post-trial NCORP site focus groups (n=10).
proposal is innovative in its 1) virtual design (clinician outreach through brief videos (Vidscrip)
and treatment delivery), 2) access and targeted cancer treatment to diverse cancer community
patients, and 3) transdisciplinary team, which includes experts in cancer care, tobacco
treatment, implementation, and community cancer trials. Demonstrating the implementation of a
videoconferencing tobacco treatment at NCORP sites will establish a pathway for disseminating
evidence based tobacco treatment and close the gap of treatment delivery in resource sparse
community oncology settings.