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Tobacco use is an established risk factor for the development of several cancers; however, far less work has been done to understand the effects of continued smoking on cancer treatment outcomes, and structured tobacco cessation efforts are not well incorporated into the standard care for patients with cancer. In this Review we discuss the known biological effects of smoking on cancer cell biology and emphasise the clinical effects of continued smoking in patients with cancer treated with chemotherapy or radiotherapy. Although evidence supports the need for inclusion of dedicated tobacco cessation efforts for patients with cancer, clinicians should consider the methods used to provide evidence-based tobacco cessation support and the available resources to deliver and maintain consistent tobacco cessation support. We also address the variables to consider in the design and implementation of a sustainable tobacco cessation programme.

Smoking is the largest contributor to lung cancer risk, and those who continue to smoke after diagnosis have a worse survival. Screening for lung cancer with low-dose computed tomography (LDCT) reduces mortality in high-risk individuals. Smoking cessation is an essential component of a high-quality screening program. To quantify the effects of smoking history and abstinence on mortality in high-risk individuals who participated in the NLST (National Lung Screening Trial). This is a secondary analysis of a randomized controlled trial (NLST). Measurements included self-reported demographics, medical and smoking history, and lung cancer-specific and all-cause mortality. Cox regression was used to study the association of mortality with smoking status and pack-years. Kaplan-Meier survival curves were examined for differences in survival based on trial arm and smoking status. Current smokers had an increased lung cancer-specific (hazard ratio [HR], 2.14-2.29) and all-cause mortality (HR, 1.79-1.85) compared with former smokers irrespective of screening arm. Former smokers in the control arm abstinent for 7 years had a 20% mortality reduction comparable with the benefit reported with LDCT screening in the NLST. The maximum benefit was seen with the combination of smoking abstinence at 15 years and LDCT screening, which resulted in a 38% reduction in lung cancer-specific mortality (HR, 0.62; 95% confidence interval, 0.51-0.76). Seven years of smoking abstinence reduced lung cancer-specific mortality at a magnitude comparable with LDCT screening. This reduction was greater when abstinence was combined with screening, highlighting the importance of smoking cessation efforts in screening programs.

Background Small cell cancer (SCC) of the esophagus is an uncommon malignancy with perceived poor prognosis, but there are few data to guide therapeutic decisions. We examined the Surveillance, Epidemiology, and End Results (SEER) database to identify prognostic factors for survival. Methods All patients with esophageal cancer in the SEER database between 1973 and 2009 were included. Univariate and multivariate analyses were performed in patients with and without SCC, examining the relationship of small cell histology, surgery, and other potential prognostic factors with overall survival (censored at 72 months). Results Of 64,799 esophageal cancer patients identified in the SEER database, 387 (0.6 %) had small cell histology. As compared with non-small cell histology, patients with small cell histology were similar in age and race but had a higher proportion of women ( p  < 0.001), had a higher stage at diagnosis ( p  < 0.001), and were less likely to undergo surgical resection ( p  < 0.01). Multivariate predictors associated with poor survival in the overall cohort included age, female gender, black race, and stage. In patients treated with surgery, multivariate predictors associated with poor survival included age, male gender, race, and stage but not small cell histology. In patients with small cell histology, both age and stage were associated with poor survival, but surgery and preoperative radiotherapy were associated with improved survival. Conclusions SCC of the esophagus presents at an advanced stage and confers a poor prognosis. The survival benefit of surgery and radiotherapy suggests that all esophageal SCC patients should be considered for preoperative radiotherapy and surgery in a stage-appropriate fashion.

Background Olfactory Neuroblastoma is a rare malignant tumor of the olfactory tract. Reports in the literature comparing treatment modalities for this tumor are limited. Methods The SEER database (1973-2006) was queried by diagnosis code to identify patients with Olfactory Neuroblastoma. Kaplan-Meier was used to estimate survival distributions based on treatment modality. Differences in survival distributions were determined by the log-rank test. A Cox multiple regression analysis was then performed using treatment, race, SEER historic stage, sex, age at diagnosis, year at diagnosis and SEER geographic registry. Results A total of 511 Olfactory Neuroblastoma cases were reported. Five year overall survival, stratified by treatment modality was: 73% for surgery with radiotherapy, 68% for surgery only, 35% for radiotherapy only, and 26% for neither surgery nor radiotherapy. There was a significant difference in overall survival between the four treatment groups (p < 0.01). At ten years, overall survival stratified by treatment modality and stage, there was no significant improvement in survival with the addition of radiation to surgery. Conclusions Best survival results were obtained for surgery with radiotherapy.

Background Though tobacco use treatment (TUT) after a cancer diagnosis can improve cancer treatment outcomes and survival, delivery of evidence‐based TUT remains underutilized in cancer care. The National Cancer Institute (NCI) Cancer Center Cessation Initiative (C3I) implemented TUT across 52 NCI‐Designated Cancer Centers, but there is little information on its long‐term sustainment. This study assesses TUT sustainment beyond initial implementation in C3I. Methods A web‐based survey across 52 C3I centers was conducted during the sustainment phase (2023–2024) following NCI C3I funding. The surveys assessed program funding and the sustainment of the overall program, program components and practices, assessment of implementation and patient outcomes, partnerships, and program scale‐out across settings. The survey data were analyzed using descriptive statistics. Results Among 47 responding sites (90% response rate), 83% reported continued TUT activity after NCI funding ended with annual operating budgets between$100,000 and $ 250,000. Most sites (78.7%) reported some institutional support, while few relied on fee‐for‐service reimbursement (27.7%), bundled payments (8.1%), or support from grants (27.7%) and philanthropic donations (21.3%). Key program components including electronic health record modifications, outcomes reporting, and staff training were largely maintained, with nearly all (46) sites continuing to screen for tobacco use and refer patients to TUT. Perceived program partnerships were strongest with clinicians and departmental leadership, and some programs were scaled out to primary care and other specialties. Conclusions Results confirm that most cancer centers sustained key TUT program functions and partnerships with some increasing TUT delivery across larger cancer treatment settings.

IntroductionContinued smoking following a cancer diagnosis has substantial health risks including increased overall and cancer-specific mortality, risk of secondary malignancies, cancer treatment toxicity and risk of surgical complications. These risks can be mitigated by quitting smoking. The preoperative period represents a prime opportunity in which to administer robust smoking cessation treatment to both improve health and support and improve surgical outcomes. We will conduct a randomised clinical trial to evaluate the effectiveness of financial incentives delivered contingent on biochemically verified smoking abstinence (contingency management (CM)) in patients with cancer undergoing surgery.Methods and analysisThe study will take place across two study sites, and participants (N=282) who smoke, are diagnosed with or suspected to have any type of operable cancer and have a surgical procedure scheduled in the next 10 days to 5 weeks will be randomised to receive standard care plus Monitoring Only or CM prior to surgery. All patients will receive breath carbon monoxide (CO) tests three times per week, nicotine replacement therapy and counselling. The CM group will also earn payments for self-reported smoking abstinence confirmed by CO breath test ≤4 ppm on an escalating schedule of reinforcement (with a reset if they smoked). Point prevalence abstinence (PPA) outcomes (self-report of 7-day abstinence confirmed by CO≤4 ppm and/or anabasine ≤2 ng/mL) will be assessed on the day of surgery and 6 months after surgery. The effect of CM on 7-day PPA at the time of surgery and 6-month follow-up will be modelled using generalised linear mixed effects models.Ethics and disseminationThis study has been reviewed and approved by the Medical University of South Carolina Institutional Review Board. We will disseminate our scientific results through traditional research-oriented outlets such as presentations at scientific meetings and publications in peer-reviewed journals.Trial registration numberNCT04605458.

Background Diagnosis of a chronic illness, such as cancer may influence health behavior changes, such as smoking cessation. The present analyses examine associations between a cancer diagnosis (i.e., yes or no) and response to an opt‐out smoking cessation bedside intervention provided to hospitalized patients. It was hypothesized that patients with a past or present cancer diagnosis would report higher motivation and engagement with quitting smoking, and higher rates of smoking abstinence after hospital discharge, compared to those without a cancer diagnosis. Methods Chart review was conducted on 5287 inpatients who accepted bedside treatment from a counselor and opted‐in to automated follow‐up calls from July 2014 to December 2019. Results At the time of inpatient assessment, those with a past or present cancer diagnosis (n = 419, 7.9%) endorsed significantly higher levels of importance of quitting than those without a cancer diagnosis (3.92/5 vs. 3.77/5), and were more likely to receive smoking cessation medication upon discharge (17.9% vs. 13.3%). Follow‐up data from 30‐days post‐discharge showed those with a cancer diagnosis endorsed higher rates of self‐reported abstinence (20.5%) than those without a cancer diagnosis (10.3%; p < 0.001). Conclusion Being hospitalized for any reason provides an opportunity for smokers to consider quitting. Having a previous diagnosis of cancer appears to increase intention to quit and lead to higher rates of smoking cessation in patients who are hospitalized compared to patients without cancer. Future research needs to work toward optimizing motivation for smoking cessation while admitted to a hospital and on improving quit rates for all admitted patients, regardless of diagnosis. This study examined responses to an inpatient tobacco treatment program between cancer and non‐cancer patients admitted to a large hospital. Results showed that during the time of hospitalization, patients with cancer felt that quitting smoking was more important and were more likely to be given medications to quit at discharge. One month after discharge, patients with cancer were more likely to have quit.

Purpose Smoking after cancer impairs cancer treatment outcomes and prognosis, regardless of cancer type. Prior data suggest that patients with cancers other than lung or head/neck cancer had lower cessation motivation, which in turn predicted lower smoking abstinence. This study evaluated feasibility for a future efficacy trial and assessed the acceptability of brief self-help materials, targeted by cancer type, to enhance cessation motivation. Methods Patients had a diagnosis of skin melanoma, breast, bladder, colorectal, or gynecological cancers within ≤ 6 months, smoked ≥ 1 cigarette in the past month, and were not currently participating in a cessation program. After completing a baseline assessment, participants received the booklet corresponding to their cancer type. Follow-ups were conducted 1 week and 1 month post-intervention. Results Among 118 patients potentially eligible, 109 were successfully contacted and 53 patients were eligible and all consented. Among consenting patients, 92.5% completed baseline, and 90.6% received the intervention. Among patients receiving the intervention, 91.7% completed all study procedures and follow-up. At 1 month, 87.5% reported reading the booklet and 92.8% rated it as good/excellent. Motivation to quit smoking increased over time among those with lower motivation at baseline, 33.3% sought smoking cessation assistance, and 25.0% were smoke-free 1 month post-intervention. Conclusion This study demonstrated the feasibility and acceptability of the first intervention developed for patients with cancers not typically associated with smoking. This low-cost and easy to disseminate intervention has potential to increase motivation to quit smoking among patients with cancers not typically perceived as smoking-related.

Background The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications. Methods We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one 6-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs. Results Median total monthly operating costs across funded centers were $11,045 (range: $5129–$20,751). The largest median operating cost category was personnel ($10,307; range: $4122–$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly (non-zero) cost ranges for other categories were medications ($17–$573), materials ($6–$435), training ($96–$516), technology ($171–$2759), and equipment ($10–$620). Median cost-per-participant was $466 (range: $70–$2093) and cost-per-quit was $2688 (range: $330–$9628), with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications. Conclusions Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.