A Mixed-Methods Study Exploring Free Nicotine Replacement Therapy as a Strategy to Promote Tobacco Treatment Equity at Cancer Center Cessation Initiative Sites

Nicotine replacement therapy (NRT) is a safe, efficacious smoking cessation treatment for cancer patients; however, equitable access is limited due to insurance gaps. Offering free NRT to patients with cancer has potential to increase tobacco treatment engagement and promote equity. This mixed-methods study aims to describe how some Cancer Center Cessation Initiative (C3I) sites implemented free NRT within their tobacco treatment programs (TTPs) to inform future development of equitable TTPs. Participating sites’ (N=9) TTP and patient population characteristics were assessed via survey and analyzed with descriptive statistics. Semi-structured interviews were conducted with 16 individuals and analyzed using directed content analysis. On average, 37.0% of patients who smoke engaged in TTPs, 48.4% of whom were prescribed cessation medication. Interviews revealed heterogeneous TTP structures, free NRT funding sources, and medication distribution models. Shared characteristics of sites’ outer settings (e.g., high proportion of patients with financial strain) often prompted free NRT program development. Shared inner setting characteristics such as inter-team collaborations, policy development, and leadership buy-in promoted implementation. Results highlight both significant heterogeneity and shared characteristics in how cancer centers might implement free NRT programs. Barriers to implementation underscore enduring challenges to providing gold standard tobacco treatment to all cancer patients in need.