Sustainability of Tobacco Cessation Programs at NCI-Designated Cancer Centers

The 2014 Surgeon General’s report provided clear evidence that smoking by cancer survivors causes adverse health outcomes and the 2020 report concluded that smoking cessation after a cancer diagnosis improves survival. Though smoking cessation improves outcomes and is advocated as a standard of care in oncology, tobacco treatment is not consistently delivered as a part of cancer care. To address this challenge, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3I) in 2017. The C3I provides financial and technical assistance through a Coordinating Center to 52 NCI-designated cancer centers to implement evidence-based tobacco treatment programs and integrate smoking cessation into routine patient care in oncology settings. All funded centers were required to sustain their programs for a minimum of three years following the NCI-funded period. However, the trajectories and determinants of sustainability for tobacco treatment programs in these cancer centers are unknown. More broadly, achieving sustained delivery of evidence-based programs over time has been identified as one of the most crucial yet understudied challenges. Our long-term goal is to develop a generalizable model for sustaining evidence- based tobacco treatment programs in cancer care. The objective of this study is to investigate the trajectories and determinants of sustainability across evidence-based tobacco treatment programs in C3I and to identify appropriate strategies for promoting sustainability using an implementation mapping approach (i.e., “sustainability mapping”). We define sustainability as the extent to which programs maintain core components, implementation strategies, and program outcomes over time. We have demonstrated the feasibility of these assessments in collaboration with the C3I Coordinating Center and participating cancer centers. The proposed study will extend this collaboration and leverage the NCI’s substantial investment in the C3I to pursue the following specific aims: 1) Characterize the sustainment of tobacco treatment programs within cancer centers; 2) Specify the relationships between multilevel determinants, strategies, and outcomes of sustainability for tobacco treatment programs within cancer centers; and 3) Develop and test a toolkit to guide the selection of sustainment strategies for tobacco treatment programs in cancer care. The proposed research offers an unprecedented opportunity for identifying how investment in building evidence-based programs is converted into sustainable healthcare systems change.