A mixed-methods study exploring free nicotine replacement therapy as a strategy to promote tobacco treatment equity at Cancer Center Cessation Initiative sites

Purpose: Nicotine replacement therapy (NRT) is a safe, efficacious smoking cessation treatment for cancer patients. However, insurance coverage for NRT varies widely, limiting its ability to lessen tobacco-related disease and creating inequities in access. Offering free NRT to cancer patients who smoke has the potential to increase tobacco treatment engagement and promote equity. This mixed-methods study aims to describe how some NCI Cancer Center Cessation Initiative (C3I) sites provided free NRT within their tobacco treatment programs (TTPs). Methods: Participating sites’ (N = 9) TTP and patient population characteristics were measured via site-level survey data and analyzed. The Consolidated Framework for Implementation Research was used to guide and analyze semi-structured interviews among 16 individuals across sites. Results: On average, 37.0% of patients who were identified as currently smoking cigarettes engaged with the TTPs, 48.4% of whom were prescribed cessation medications. Interviews revealed heterogeneous TTP structures, funding sources for free NRT, and medication distribution models. Patient financial strain appeared to frequently prompt free NRT program development. Common site factors that supported free NRT programs included inter-team collaborations, policy development, and leadership buy-in. Conclusion: Results highlight both significant heterogeneity and shared factors in how cancer centers might implement free NRT programs. Barriers to implementation and sustainability underscore enduring challenges to providing gold standard tobacco treatment to all patients with cancer who use tobacco. Future research should investigate how to best provide equitable access to tobacco treatment among this population.