High Variability, Gaps in Care Observed in Smoking Assessment Implementation Around the US


These findings highlight the gaps in care among patients with cancer with regard to smoking assessments.

Implementation of cigarette-smoking evaluations and treatment within accredited cancer programs are variable across a wide variety of factors, according to recent findings, suggesting persistent gaps in cancer care throughout the US.1

These data and other findings were highlighted in a recent, comprehensive national survey regarding tobacco treatment in cancer care in a wide array of clinical oncology environments. The survey was part of a national improvement in quality initiative by the American College of Surgeons (ACS) looking at cancer centers and their work in encouraging smoking cessation.

This survey research was led by Jamie Ostroff, PhD, Timothy Mullett, MD, FACS, MBA, Eileen M. Reilly, MSW, and others. Mullett and colleagues’ findings were published in JCO Oncology Practice.

“While many people understand the role of tobacco in terms of causing cancer, they may not understand the impact that tobacco use has when patients are being treated for cancer,” Mullett, chair of the ACS Commission on Cancer (CoC), said in a statement. “Additionally, many providers may not think about tobacco cessation in terms of treatment. But just like there are effective treatments for high blood pressure or thyroid disease, there are effective treatments for tobacco use.”2

Survey Background and Methods

The investigators highlighted the many complications known to result from persistent cigarette-smoking among cancer patients, some of which can include recurrence of cancer, diminished rates of survival, and treatment cost increases. Almost 25% of new cancer patients and about 16% of survivors in the US are known to continue smoking, with cessation success rates remaining below 10%.1

The investigators began the Just ASK Quality Improvement (QI) project in 2022, with the overall aim being to enhance the universal assessment and documentation of patients’ smoking status in their electronic health data and to encourage care providers to inquire about cigarette habits and educate their patients on the potential benefits of quitting. The project’s leaders were all from the American College of Surgeons National Accreditation Program for Breast Centers (NAPBC) and the CoC.

There were about 776 programs that had been accredited by the CoC or NAPBC which chose to take part in the study’s baseline survey out of 2,000 programs that had received invitations. The investigators noted that this rate of participation, along with other QI initiatives, was a reflection of the high priority placed by many programs on assessments of smoking and cancer care initiatives.

Despite this conclusion by the research team, they added that their survey results would indicate that there was substantial variability in the implementing of cigarette smoking cessation practices across the country.


Despite their finding that most centers made inquiries about patients’ status related to smoking cigarettes—documenting history of smoking and advising individuals to terminate the habit—the research team reported that fewer than 50% had documented a plan designed for smoking cessation treatment.1

Additionally, the investigators reported that only a fraction of the programs they had evaluated made steps to assist their patients in the process of quitting through programs such as counseling. Only a percentage referred such patients to treatment programs related to tobacco use.

Barriers that the team identified to tobacco treatment delivery included numbers of designated specialists, a lack of staff training, resources, and general resistance by patients, among others. The survey investigators recommended, for the sake of enhancing care, the implementing of proactive screening initiatives, the establishment of learning collaboratives based on gaps, the prioritizing of training for staff members, and the provision of referrals and resources in the community for smoking needs.

Additionally, the team emphasized the necessity of additional research with the goal of evaluating strategies necessary for improving evidence-based smoking treatment among the variety of cancer care settings.

“We are at the transition point of needing to transform the knowledge of what we know to how we do it,” first author Jamie Ostroff, PhD, said in a statement. “With data and expert input, we will be able to develop and test strategies to close that gap between what we know is a best practice, and what we observe is happening.”2


  1. Implementation Strategies for Improving Quality of Smoking Cessation Support in Accredited Cancer Programs of the American College of Surgeons. JCO Oncology Practice, 2023. DOI: https://doi.org/10.1200/OP.23.00393.
  2. Smoking Is an Undertreated Risk Factor After a Cancer Diagnosis. American College of Surgeons (ACS). March 13, 2024.
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