Virtual Sustained Counseling Plus NRT Nearly Doubles Smoking Quit Rates in Cancer Patients: ECOG-ACRIN Trial
核心洞察
Virtual sustained counseling combined with nicotine replacement therapy nearly doubled 6-month smoking quit rates (28.4% vs 14.7%) compared with enhanced usual care in a randomized controlled trial of 306 cancer (搜索) patients across 37 community oncology sites.
The opt-out No Smoker Left Behind initiative at University of Chicago reached 54.6% of eligible patients, with 43.1% selecting one or more treatment options and 16.2% achieving at least 8 days of abstinence at 6-month follow-up.
Both studies demonstrate that proactive, virtual tobacco treatment models are feasible, cost-effective, and scalable for integrating smoking cessation into routine community oncology care.
Persistent smoking among patients diagnosed with cancer (搜索) is associated with adverse clinical outcomes, yet tobacco treatment has not been well-integrated into community oncology settings. Now, findings from two major initiatives—the randomized controlled ECOG-ACRIN EAQ171CD trial and the University of Chicago's No Smoker Left Behind program—demonstrate that virtual, sustained cessation interventions can meaningfully improve quit rates and should be considered essential to comprehensive cancer care.
"Tobacco treatment is simply essential for quality, comprehensive cancer (搜索) care, and our study shows virtual, sustained cessation treatment is an effective way to accomplish that," said Elyse R. Park, PhD, MPH, Program Director of the Mass General Brigham Cancer Institute (搜索)'s Smokefree Support Service and lead author of the ECOG-ACRIN trial, published in the Journal of Clinical Oncology.
ECOG-ACRIN EAQ171CD: Virtual Intervention Nearly Doubles Quit Rates
The NCI Community Oncology Research Program trial enrolled 306 English- and Spanish-speaking patients from 37 community sites nationwide. Patients were randomly assigned to either sustained telehealth counseling plus up to 12 weeks of free nicotine replacement therapy (NRT) or referral to the NCI's quitline, considered enhanced usual care.
At 6 months, the 7-day abstinence rate reached 28.4% in the virtual sustained treatment group compared with 14.7% in the enhanced usual care group—an almost twofold improvement. Within the intervention arm, 80.8% engaged in counseling and 85.7% were dispensed free NRT. Patients completing more than 8 counseling sessions were significantly more likely to quit than those completing fewer than 5 sessions (P = .005). Those in the virtual sustained treatment group were also nearly four times more likely to report guideline-concordant smoking cessation medication use.
The incremental cost per patient who quit was $7,724.
"Our findings show that patients are willing to engage in virtual sustained tobacco treatment and that this approach can meaningfully improve quit rates in community-based oncology practice," said co-study lead Jamie S. Ostroff, PhD, Chief of Behavioral Sciences Service at Memorial Sloan Kettering Cancer Center. "Virtual sustained counseling combined with nicotine replacement therapy offers a practical, cost-effective and scalable model of tobacco treatment delivery that can reach patients wherever they receive care."
Of the participants, 73.2% smoked within 30 minutes of waking—indicating high nicotine dependence—and 45.4% had non-smoking-related cancers. The researchers reported no significant treatment moderators, suggesting broad applicability across patient subgroups.
No Smoker Left Behind: An Opt-Out Model for Systematic Reach
At The University of Chicago Comprehensive Cancer Center (搜索), Andrea C. King, PhD, and colleagues developed the No Smoker Left Behind initiative, an opt-out program that proactively reaches out to all patients with cancer (搜索) listed as current smokers in the electronic health record.
"Helping patients to quit smoking should be a standard of care," said King, professor of psychiatry and behavioral neuroscience at The University of Chicago.
A retrospective analysis of the program's first 6 years (2019–2024) included 3,706 eligible patients (mean age 62.1 years; 57% men; 46.6% Black; 38.5% white). Of these, 2,024 patients (54.6% of those attempted) were reached. Among those reached, 43.1% selected and were referred to one or more treatment options. The most common patient-selected options included medication with counseling (70.6%), medication alone (14.8%), and a text-only program (8.8%).
Among 327 respondents to the final 6-month follow-up, 16.2% abstained from smoking for at least 8 days, 58.7% reported attempting to quit within the previous month, and 15% reported smoking less than at program enrollment. Patients with smoking-related malignancies had significantly higher abstinence rates than those with non-smoking-related cancers (23.7% vs. 14.7%; P = .022).
The program had a median annual cost of $64,279, with a cost of $183 per person reached, $415 per referred patient, and $6,067 per quit.
Addressing a Critical Gap in Cancer (搜索) Care
Tobacco use causes 28% of all cancer (搜索) deaths in the U.S., and among patients diagnosed with a malignancy in 2023, 14.7% reported being current smokers. Despite this, more than 71% of American College of Surgeons' Commission on Cancer–accredited programs advise patients to stop smoking, but only 18.2% provide counseling and just 17.6% prescribe approved medications.
"We are going to help people," King said. "We are going to repeatedly help you to try to find a way to reduce and quit smoking."
The No Smoker Left Behind initiative may serve as a model for other centers to meet benchmarks for the new standard introduced by the American College of Surgeons Commission on Cancer (搜索) in January 2026, which requires accredited cancer centers to implement a process for screening all new cancer patients for smoking status and refer those who currently smoke to evidence-based smoking cessation services.
"I hope more cancer (搜索) centers can implement something like this program to ensure sustainability," King said. "I hope that can be the future."