No Smoker Left Behind: Evaluation of a Population-Based, Opt-Out Smoking Cessation Program for Patients With Cancer Who Smoke

PURPOSE We evaluated the reach, treatment selection, and effectiveness of a population-based, opt-out smoking cessation outreach program, No Smoker Left Behind, implemented in a socioeconomically and racially diverse cancer patient population. METHODS Patients seeking oncology care at the University of Chicago Comprehensive Cancer Center between 2019 and 2024 were screened for smoking status as documented in the electronic health record. Adults age 18 years and older categorized as currently smoking (past month) were systematically contacted via interactive voice response phone calls, texts, and emails for up to 6 months. They were offered several cessation treatment options, including medication and counseling referrals (ie, group program, quitline, and text message program). Program involvement and cessation outcomes were compared by cancer type (ie, smoking- or non–smoking-related) and race. A cost-outcome analysis was also conducted. RESULTS Of 37,478 patients with cancer, 3,706 (9.9%) were deemed eligible and contacted, of whom 57.0% were male, 46.6% Black, and 63.8% publicly insured. Of those selecting cessation treatments (n = 1,089), most self-selected both medication and counseling (70.6%), with 873 receiving referrals or connection to cessation support. Among patients who completed day 180 follow-up (37.5% of those receiving referrals), 16.2% (53/327) self-reported ≥8-day abstinence. Patients with smoking-related cancers had higher abstinence rates than patients with non–smoking-related cancers (23.7% v 14.7%). Black patients had higher program involvement and treatment referral rates, but significantly lower smoking abstinence compared with White patients (14.4% v 25.7%). Costs-per-patient referred to treatment were $415 US dollars (USD) and costs-per-quit were $6,067 USD. CONCLUSION Population-based, proactive opt-out outreach programs provide a feasible approach for offering multiple cessation treatment options that allow for patient preference and customization to optimize treatment accessibility. As health care systems expand access to tobacco cessation as part of cancer care, implementing resource-efficient models will become increasingly important.