Programs participating in the American College of Surgeons (ACS) Just ASK project—the largest-ever quality improvement initiative to focus on the critically important issue of smoking among cancer patients—dramatically increased rates of assessing and documenting patients’ smoking status at cancer centers accredited by the ACS Commission on Cancer (CoC).
Results of the quality improvement project and clinical study were reported in the Journal of Clinical Oncology.
Smoking among patients diagnosed with cancer is associated with treatment-related complications in addition to cancer recurrence, poor survival, and increased treatment costs. Despite these risk factors, nearly 25% of new patients with cancer and 16% of cancer survivors report current smoking.
Initiated by the ACS CoC in 2022 to increase smoking assessment among CoC-accredited cancer programs, the Just ASK quality improvement initiative was implemented at 762 cancer care facilities nationwide and included engagement from almost 50% of accredited CoC programs—making it one of the largest efforts of its kind to improve smoking assessment and documentation in cancer care settings, the authors said. After implementing the initiative, assessment rates increased to nearly 92% by the end of the one-year program, and participation in the program was associated with sustained practice changes in smoking assessment, cessation advice, and related documentation, meaningfully advancing the quality of care delivery, the authors wrote.
“Smoking assessment, or ‘just asking,’ is an important first step in helping patients with cancer access evidence-based smoking cessation treatment, which can improve their cancer treatment outcomes,” said Timothy W. Mullett, MD, MBA, FACS, immediate past Chair of the CoC and senior author of the study. “With this study, we have shown that it is both feasible and practical to increase smoking cessation resources in a wide range of oncology settings, including at larger academic facilities and small community cancer programs.”
Participating programs gained access to an online toolkit that contained information about evidence-based smoking assessment and cessation assistance practices, technical tools, and training and education opportunities. Programs implemented several practical recommendations to improve smoking assessment for patients with cancer, including training staff and providers, developing patient education materials, and improving smoking-related documentation.
“What this study shows is that we can successfully make population-based smoking assessment a standard part of cancer care,” said Jessica L. Burris, PhD, lead author of the study and co-leader of the Cancer Prevention and Control Research Program at the University of Kentucky Markey Cancer Center. “This is important because before providers can help patients quit smoking—which we know improves their health outcomes and reduces treatment costs—they first need to identify who needs that support. Providers being proactive in asking about smoking and offering support is key since stigma and guilt will stop some patients from asking for the help they need to quit successfully.”
A second ACS quality improvement project called Beyond ASK addresses building programs’ capacity to offer cessation assistance.
Study co-authors with Dr. Mullett and Dr. Burris are Jamie S. Ostroff, PhD; Eileen M. Reilly, MSW; Graham W. Warren, MD, PhD; and Rachel C. Shelton, ScD, MPH.
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA177558.
Text adapted from “Markey research shows success in national smoking assessment program,” published by University of Kentucky Research News, November 20, 2024.
