New research published by Ramsey et al in JNCCN—Journal of the National Comprehensive Cancer Network has found that the inclusion of the smoking cessation tool Electronic Health Record–Enabled Evidence-Based Smoking Cessation Treatment (ELEVATE) into electronic health records may increase self-reported patient quit rates by more than 5%.
The study, from researchers at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, was part of the National Cancer Institute Cancer Moonshot program through the Cancer Center Cessation Initiative.
Active smoking after a cancer diagnosis is associated with worse outcomes, lower survival rates, higher risk of additional cancers, and more frequent and severe side effects from cancer treatment. The oncology community agrees that it is never too late to stop smoking. However, far too many patients are not receiving adequate counseling and support according to evidence-based smoking cessation guidelines.
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“ELEVATE seems to be emerging as a relatively rare example of a program that enables access to high-quality smoking cessation care while minimizing costs and burden,” said lead researcher Alex T. Ramsey, PhD, a Washington University researcher at Siteman Cancer Center. “ELEVATE features an easy-to-use smoking module built into the electronic health record that cues actions by multiple members of the oncology care team to assess smoking status, provide cessation advice, prescribe cessation medications, and offer a variety of cessation counseling options to patients who smoke.”
“We must make sure oncology providers are fully supported by the entire health-care team and have access to efficient electronic health record decision support,” explained senior researcher Li-Shiun, Chen, MD, MPH, ScD, also of Siteman Cancer Center and Washington University. “We were pleasantly surprised to see how eager oncology providers are to transform their practice in order to offer tobacco treatment as part of routine care, as long as this evidence-based care is baked into their workflow and electronic health record. ELEVATE offers an innovative, low-burden paradigm shift so tobacco cessation strategies can be fully embedded into point-of-care for every oncology visit.”
More on ELEVATE’s Success
A total of 3,238 medical oncology patients documented in the electronic health record with a current smoking status were studied in the pre-implementation period (January through May 2018) and postimplementation period (June through December 2018). In the subsequent 6-month follow-up periods, 12% of those treated prior to the implementation of ELEVATE had documented smoking cessation, compared to 17.2% of those treated after implementation.
The researchers also compared the rates of cessation for medical oncology patients vs surgical oncology patients and general internal medicine patients at Washington University over the same time periods, who did not have access to the ELEVATE program during either time. That population group consisted of 9,719 patients who smoked without a known cancer diagnosis. They found no significant changes in the rate of smoking between the two time periods for this noncancer group.
“Abstinence from smoking is a critical component of cancer care,” commented Christine E. Sheffer, PhD, of Roswell Park Comprehensive Cancer Center, who was not involved with this research. “The findings from this pre-post quasi-experimental study, conducted from 2018 to 2019, demonstrate the utility of using an electronic health record–enabled cessation tool to reach patients [with cancer] with a moderate intervention for smoking cessation.”
Dr. Sheffer, a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Smoking Cessation, continued, “Although the proportion of patients for whom a period of abstinence was reported during the 6 months after the intervention increased significantly, it still falls short of an obligation to provide long-term effective smoking cessation treatment as a critical component of care. Combining an electronic health record–enabled cessation tool with NCCN-recommended counseling and pharmacotherapy has the potential to further increase the proportion of patients who achieve, and maintain, abstinence from smoking.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
