Rural and Appalachian cancer survivors’ responses to tobacco use screening and tobacco treatment offer

INTRODUCTION Smoking after a cancer diagnosis is associated with poor outcomes whereas smoking cessation improves survival and other outcomes. Although professional societies and practice guidelines call for equitable tobacco treatment delivery in healthcare, disparities in tobacco-related disease burden persist. METHODS In the context of an outpatient US cancer center’s population-based tobacco treatment program, this study examines associations between cancer survivors’ rural and Appalachian residence status and: 1) current tobacco use status, 2) decision to decline tobacco treatment, and 3) reason for declining assistance. A cross-sectional, retrospective analysis was conducted using electronic health record data from 16839 adults: 64.04% female, 88.49% non-Hispanic White, mean age 59.19 ± 14.52 years, 35.97% rural residence, 53.14% Appalachian residence, who sought cancer care in 2019. Descriptive statistics and logistic regression models were applied. RESULTS The portion of patients that reported current tobacco use was 21.75%. Rural patients had higher odds of tobacco use than urban (OR=1.22; 95% CI: 1.12- 1.34), as did Appalachian patients compared to non-Appalachian (OR=1.41; 95% CI: 1.28-1.54). Neither rural nor Appalachian residence status was significantly associated with responses to tobacco treatment offers (76.65% declined the offer) or reason for declining (65.19% declined because they were ʼnot ready to quit’). CONCLUSIONS Findings highlight continued need for population-level tobacco use screening and proactive tobacco treatment offers, given elevated tobacco use in some minority groups and overall low rates of tobacco treatment acceptance. This large study helps shed light on the association between geographical residence and tobacco-related outcomes among patients with cancer, and underscores room for improvement in tobacco treatment uptake in cancer care.