Toll, Benjamin A.

Abstract Introduction Tobacco use can adversely affect cancer treatment outcomes, yet routine assessment has not been fully incorporated into oncology clinical trials. In 2012, rates of tobacco use assessment in actively accruing National Cancer Institute (NCI) trials were < 30% at enrollment and < 5% during follow-up, prompting efforts by the NCI and major oncology associations to promote and standardize tobacco assessment in oncology research and practice (including development of the Cancer Patient Tobacco Use Questionnaire [C-TUQ]). This study was conducted to re-examine assessment patterns in 2022 (including utilization of the C-TUQ) and evaluate progress. Aims and Methods Protocols and forms from 144 actively accruing (as of December 2022) NCI National Clinical Trials Network (NCTN) trials were evaluated using a standardized coding instrument. Results Of 144 trials, 49.3% assessed tobacco use at enrollment (43.8% measured cigarettes, 14.8% e-cigarettes, and ≤ 12.5% other tobacco products). Approximately 20.8% used at least one C-TUQ question, but only 3.5% used all four core items. Few measured second-hand smoke exposure (3.5%) or quit interest (2.8%). At follow-up, 8.3% assessed any form of tobacco use. Assessment rates were higher in smoking-related cancer trials. Conclusions Almost half of the accruing trials did not measure any tobacco use and fewer used the C-TUQ. There was a ≥ 70% increase in tobacco use assessment at enrollment and follow-up compared to 2012, an improvement with room for further enhancement. Standardized tobacco use information enhances investigators’ ability to estimate cancer treatment efficacy, offer equitable cessation support, and accurately understand the impact of tobacco use on treatment outcomes. Implications In 2012, few (< 30%) cancer clinical trials evaluated tobacco use at enrollment and < 5% did so during follow-up, prompting efforts to promote and standardize tobacco assessment in oncology research and practice (including the development of the Cancer Patient Tobacco Use Questionnaire [C-TUQ]). The present study builds on this foundational paper and finds an overall increase in tobacco use assessment with room for improvement: 49.3% of trials in 2022 assessed tobacco use at enrollment and 8.3% did so during follow-up. About 20.8% used at least one C-TUQ question, highlighting that tobacco use assessment is not yet fully incorporated into oncology clinical trials.

Abstract There is strong evidence that cigarette smoking causes adverse outcomes in people with cancer. However, more research is needed regarding those effects and the effects of alternative tobacco products and of secondhand smoke, the effects of cessation (before diagnosis, during treatment, or during survivorship), the biologic mechanisms, and optimal strategies for tobacco dependence treatment in oncology. Fundamentally, tobacco is an important source of variation in clinical treatment trials. Nevertheless, tobacco use assessment has not been uniform in clinical trials. Progress has been impeded by a lack of consensus regarding tobacco use assessment suitable for cancer patients. The NCI-AACR Cancer Patient Tobacco Use Assessment Task Force identified priority research areas and developed recommendations for assessment items and timing of assessment in cancer research. A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve the measurement items. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes “Core” items for minimal assessment of tobacco use at initial and follow-up time points, and an “Extension” set. Domains include the following: cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption of the recommended measures and timing protocol, and pursuit of the recommended research priorities, will help us to achieve a clearer understanding of the significance of tobacco use and cessation for cancer patients. Clin Cancer Res; 22(8); 1907–13. ©2016 AACR.

Abstract Purpose: The purpose of this study was to evaluate oncologists' preferences for methods to increase delivery of tobacco cessation support to cancer patients. Methods: An email list of 6844 physicians at NCI Designated Cancer Centers was generated using publically available online resources. An online survey was conducted in the fall of 2013 to assess tobacco assessment and cessation practices by physicians, barriers to providing cessation support, and methods to improve access to cessation services for cancer patients. Results of this survey are compared to similar survey findings by the American Society of Clinical Oncology (ASCO) and the International Association for the Study of Lung Cancer (IASLC). Results: Of 6844 electronically delivered survey invitations, we received 887 responses (13%). Consistent with previously published ASCO and IASLC surveys, 90% of physicians agreed that tobacco use by patients affects cancer treatment outcomes (vs. 87-92% in ASCO/IASLC), 90% of respondents reported that they ask patients about their tobacco use (vs. 90% in ASCO/IASLC), and 83% routinely advise tobacco users to quit (vs. 80-82% in ASCO/IASLC). However, only 37% of respondents regularly discussed medications, and 35% actively treated patients (vs. 39-44% in ASCO/IASLC). Most (71%) responding oncologists preferred cessation support be provided at the initial patient consult, and few (11%) were concerned about the use of tobacco cessation medications. Lack of time and lack of available resources were the dominant barriers to the administration of tobacco cessation support to cancer patients by oncologists. Only 10% of oncologists believed they were adequately trained to counsel patients on smoking cessation, but 55% reported that training for someone else in their clinic would increase tobacco cessation support. When asked what provider they prefer to administer cessation support to cancer patients, 16% reported a primary care physician, 18% reported a mid-level (nurse practitioner or physician assistant), 50% reported any other clinical staff, and only 1% preferred to personally provide cessation support. Whereas most (58%) oncologists preferred to have dedicated cessation services within their institution, 38% reported they would use dedicated services either within, or outside their institution. Conclusions: Most oncologists at NCI Designated Cancer Centers recognize the importance of tobacco cessation, but prefer to have tobacco cessation support for cancer patients provided by another trained professional. Citation Format: Alix Pommerenke, Anthony Alberg, Thomas H. Brandon, Ivana Croghan, Michael K. Cummings, Carolyn Dresler, Ellen R. Gritz, Roy Herbst, Scott Leischow, James R. Marshall, Benjamin Toll, Graham Warren. Physician preferences in tobacco cessation support for cancer patients: A survey of physicians at National Cancer Institute Designated Cancer Centers. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5049. doi:10.1158/1538-7445.AM2014-5049