Virtual Tobacco Treatment Program Doubles Quit Rates for Cancer Patients

A comprehensive, sustained telehealth tobacco treatment program doubled smoking cessation rates among patients recently diagnosed with cancer, compared to referral to a quitline alone, according to results from the nationwide Smokefree Support Study 2.0 (EAQ171CD) published in the Journal of Clinical Oncology.

The study enrolled 306 patients from 37 NCI Community Oncology Research Program (NCORP) sites. Participants were randomly assigned to receive either 6 months of proactive telehealth counseling and nicotine replacement therapy (NRT) or a referral to the NCI's quitline, considered enhanced usual care. At 6 months, 28.4% of the intervention group were not using tobacco, compared to 14.7% in the control group. Among those who quit, more than half did so within the first 3 months, and relapse rates remained low.

Engagement differed sharply between the groups: 81% of patients in the sustained intervention attended counseling sessions, whereas only 5% of those referred to the quitline completed even a single session. Self-reported NRT use at 6 months was 83% in the intervention group versus 49.5% in the control group. Patients in the intervention were almost four times more likely to report guideline-concordant smoking cessation medication use.

The incremental cost per patient who quit was $7,724.

The lead author stated, "Our study shows that patients undergoing cancer treatment are much more likely to quit smoking when they receive proactive, sustained support rather than a referral alone. Just as importantly, these findings demonstrate that evidence-based tobacco treatment can be successfully integrated into routine community oncology care." The senior author added, "Integrating sustained tobacco treatment into community oncology settings can help close a critical gap in cancer care delivery. These findings support the next step of testing how best to scale up sustained, virtual tobacco treatment across community oncology settings."

Patient satisfaction was high: about 90% of intervention recipients reported receiving the smoking cessation assistance they wanted, compared to 40% in the control group. Participants valued the regular check-ins, behavioral coaching, coping strategies for smoking urges, and NRT.

Persistent smoking among cancer patients is associated with adverse outcomes, including increased treatment toxicity, reduced therapy effectiveness, and higher risk of recurrence. Yet most cancer patients receive only brief advice to quit without actual cessation assistance. The trial's pragmatic design and broad eligibility criteria reflect routine community oncology practice.