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Background: Tobacco control is important for cancer patient health, but delivering effective low-dose CT (LDCT) screening and tobacco cessation is more difficult in underserved and patients from racial and ethnic minority groups. At City of Hope (COH), we have developed strategies to overcome barriers to the delivery of LDCT and tobacco cessation. Methods: We performed a needs assessment. New tobacco control program services were implemented focusing on patients from racial and ethnic minority groups. Innovations included Whole Person Care with motivational counseling, placing clinician and nurse champions at points of care, training module and leadership newsletters, and a patient-centric personalized medicine Personalized Pathways to Success (PPS) program. Results: Emphasis on patients from racial and ethnic minority groups was implemented by training cessation personnel and lung cancer control champions. LDCT increased. Tobacco use assessment increased and abstinence was 27.2%. The PPS pilot program achieved 47% engagement in cessation, with self-reported abstinence at 3 months of 38%, with both results slightly higher in patients from racial and ethnic minority groups than in Caucasian patients. Conclusions: Tobacco cessation barrier-focused innovations can result in increased lung cancer screening and tobacco cessation reach and effectiveness, especially among patients from racial and ethnic minority groups. The PPS program is promising as a personalized medicine patient-centric approach to cessation and lung cancer screening.

We designed a process to increase tobacco cessation in an academic center and its widely distributed network community sites using clinical champions to overcome referral barriers.In 2020 a needs assessment was performed across the City of Hope Medical Center and its 32 community treatment sites. We reviewed information science strategies to choose elements for our expanded tobacco control plan, focusing on distributed leadership with tobacco cessation champions. We analyzed smoking patterns in patients with cancer before and following program implementation. We evaluated the champion experience and measured tobacco abstinence after 6 months of follow-up.Cancer center leadership committed to expanding tobacco control. Funding was obtained through a Cancer Center Cessation Initiative (C3I) grant. Multi-disciplinary leaders developed a comprehensive plan. Disease-focused clinics and community sites named cessation champions (a clinician and nurse) supported by certified tobacco treatment specialists. Patient, staff, clinician, and champion training/education were developed. Roles and responsibilities of the champions were defined. Implementation in pilot sites showed increased tobacco assessment from 80.8 to 96.6%, increased tobacco cessation referral by 367%, and moderate smoking abstinence in both academic (27.2%) and community sites (22.5%). 73% of champions had positive attitudes toward the program.An efficient process to expand smoking cessation in the City of Hope network was developed using implementation science strategies and cessation champions. This well-detailed implementation process may be helpful to other cancer centers, particularly those with a tertiary care cancer center and community network.

Background: Minority cancer patients (pts) who use tobacco often decline tobacco cessation programs due to variable personal barriers and priorities. We developed a Personal Pathway to Success (PPS) program to overcome barriers and improve patient (pt) engagement. PPS allowed pts to choose cessation components they were willing to initially use. Methods: City of Hope (COH) tobacco cessation program developed a comprehensive list of evidence-based cessation services. Pts completed tobacco use and a Lifestress Scale assessing societal determinants of distress. PPS was then tailored and offered to pts to create their iquit strategy. Pts could add or delete components at any time as engaged partners in cessation care. Pts were evaluated by demographic group. Since tobacco use is associated with adverse surgical outcomes, we tested the PPS program in the preoperative anesthesia testing clinic (PATC). Results were compared by Chi square statistics. Study data collection was 9/2021 to 2/2022. Results: The components of PPS were individual cessation counseling, individual motivational counseling, nicotine replacement and cessation medications, signed personal commitment agreement, English and Spanish cessation support groups, choosing a buddy partner (family, friends or support group), lung cancer screening, letter to primary care physicians requesting assistance for non-responding pts, SmokeFree Text support, Kick It California or Asian Smokers' Quitline support, rapid action plan for relapses, 5Ds cessation and 7 self-care skills, COH relaxation and/or hypnosis videos, guidance for cinnamon stick/bubble blowing, stress management and smoking cessation apps, Tobacco Cessation as Recovery Enhancement video and audios, educational brochures, advice on vaping, assistance with internet and digital devices, family education and support, and psycho-social or substance abuse referrals. Current results are based on the initial 53 evaluable pts. 100% viewed the educational video. Only 7 pts (13%) were passive-refusal despite 3 attempts and were referred back to their attending physician for added cessation referral. 26 patients (49%) agreed to cessation counseling. Of these 88% completed the counseling. 36% of pts were minority (47% were Latinx, 21% Black/African American, and 32% Asians). All minority pts had motivational counseling. 67% of Latinx and 75% of Black pts also had cessation counseling. Abstinence was achieved by 58% of minority pts, but only 24% of Caucasian pts (p=0.015). Abstinence was achieved by 50% of pts accepting cessation counseling, and even 35% of pts who received only video and brochure education (p=0.28). Overall program metrics showed cessation counseling was increased from 8.7% pre-PPS to 49% with PPS (p Citation Format: Cary A. Presant, Kimlin Ashing, Sophia Yeung, Jonjon Macalintal, Brenda Gascon, Argiela Sandoval, Mary Cianfrocca, Ravi Salgia, Dan Raz, Loretta Erhunmwunsee, Yuman Fong, Steven Rosen. Enhancing minority patient participation in tobacco cessation by a personal pathway to success program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A095.

Background: Cancer patients who use tobacco often decline to participate in structured tobacco cessation programs. and personal barriers and priorities vary. To overcome barriers and improve pt engagement, we constructed a Personal Pathway to Success (PPS) program which enabled patients to choose cessation components they could effectively use. Methods: City of Hope (COH) constructed a comprehensive list of cessation tools. Patients completed tobacco use and Lifestress social domain stress assessments. PPS was then proposed to patients who selected tools they would initially use in quit attempts. Pts could add or delete tools at any time but were encouraged to add likely effective tools. Since tobacco use is associated with adverse surgical outcomes, the PPS program was pilot tested at the preoperative anesthesia testing clinic (PATC). Patients were evaluated for acceptance of cessation and follow through with counseling. Results were compared by Chi square statistic to pt cessation results before PPS program implementation. Study data collection was 9/11/21 to 1/3/22.Results: The tools in PPS were Individual cessation counseling, nicotine replacement and cessation medications, signed personal commitment agreement, cessation support group, choosing a buddy partner (family, friends or support group), lung cancer screening, letter to primary care physicians requesting assistance for non-responding patients, SmokeFree Text support, Kick It California or Asian Quitline support, rapid action plan for relapses, 5Ds cessation and 7 self-care skills, COH relaxation and/or hypnosis videos, guidance for cinnamon stick/bubble blowing, stress management and smoking cessation apps, cessation videos and audios, educational brochures, advice on vaping, assistance with internet and digital devices, family education and support, and psycho-social or substance abuse referrals. At PATC 36 evaluable patients were offered the PPS program, counseling and/or video education. Nineteen patients (53%) agreed to cessation, 14 (74%) scheduled a definite date for counseling. 42% completed the counseling. Video education was watched by 6 (32%) patients. Thirty two % had future appointments, but 26% had not yet scheduled. Three patients (8%) desired more time to evaluate cessation. Fourteen patients did not respond despite 3 attempts and were referred back to their attending physician. Compared to results pre-PPS, patient initiation was increased from 8.7% to 53% (p Conclusions: The Personal Pathway to Success program empowered patients to select among different cessation tools and increased pt acceptance of cessation. Offering comprehensive tobacco cessation during cancer surgery pre-anesthesia visits represents a teachable moment when patients are more motivated to accept behavioral interventions and tobacco cessation. Further research will develop additional methods to further increase engagement of hard to reach patients, family and caregivers. Citation Format: Cary A. Presant, Kimlin Ashing, Sophia Yeung, Jonjon Macalintal, Brenda Gascon, Argelia Sandoval, Brian Tiep, Mary Cianfrocca, Ravi Salgia, Dan Raz, Loretta Erhunmwunsee, Yuman Fong, Steven Rosen. Empowering tobacco using cancer patient initiation of tobacco cessation by a personal pathway to success program during preoperative patient counseling: A feasibility study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB553.

Background: Implementing tobacco cessation has been challenging across multi-racial and multi-ethnic regional communities. Multilayered influences of Societal Determinants of Health (SDH), social risks, environment, role of stress and perceived levels, tobacco addiction and behaviors are complex. Effective identification of social risk factors and unmet social needs of individuals can enhance tobacco treatment quality, and care coordination across the healthcare continuum. Integrating SDH and Implementation science into electronic health record (EHR) can provide both value and principles that promises to enhance patient and community responsiveness to address Catchment Area cancer burden and health disparities. Methods: We included a 33 item SDH measure to our tobacco use assessment (TUA) instrument and applied implementation science with tobacco cessation program at City of Hope (COH). Our SDH assesses patients’ appraisal of their contextual distress including access to primary and cancer related medical care, technology and digital access and proficiency, food insecurity, career/job, income, education distress; housing, living situation and social network/isolation and racism and discrimination stress. The measure follows a 5pt likert scale ranging from extreme stress to no stress. Results: This study compared 173 self-reported TUA. The mean age of first smoked a cigarette was 16 y.o. The mean age of first began smoking cigarettes regularly was 18 y.o. The mean total years of smoking was 36 years. Most participants were everyday smokers and on average, participants smoked I pack/day. >50% of the patients lived in a place where other people smoked cigarettes indoors. 55% of the patients tried to quit in the past 30 days. 60% of the patients indicated that it is EXTREMELY important for them to quit smoking/tobacco and indicated interest in tobacco cessation. Half of the patients indicated they are NOT SO confident in their ability to quit smoking/tobacco. Below are the items commonly endorsed as extreme stressful: Health and cancer outcomes, using telehealth (e.g., using a smartphone or tablet for tele/virtual clinical visits, patient portal, completing online forms, virtual classes), money or finances, and functional strain (e.g., family demands). Conclusions: SDH is complex and multilayered as well as understudied. The results support the small body of research documenting the necessity and utility of measuring and addressing SDH to correct health disparities. Increased prioritization including assessing and intervening with strategic planning and IT integration is required to better understand and address the cancer impact including tobacco cessation relevant to SDH. Successful tobacco control programs can benefit from IT integrated, culturally and community informed SDH assessments using implementation science principles. Citation Format: Kimlin T. Ashing, Sophia Yeung, Cary A. Presant, Jonjon Macalintal, Brian Tiep, J Sandoval, Brenda Gascon, R Salgia, Susan J. Brown, Steven Rosen. Incorporating societal determinants of health with implementation science to increase tobacco cessation patient and community responsiveness [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3677.