RE-AIM Guided Evaluation of a Comprehensive Tobacco Treatment and Education Program at a Cancer Center

Approximately 60% of patients with cancer have a history of smoking, and 20% continue to smoke after diagnosis. Despite the importance of smoking cessation for patients with cancer, it has been estimated that half of these patients are not offered smoking cessation treatment. Smoking cessation is an important element of comprehensive cancer care, and as such, the NCI developed the Cancer Center Cessation Initiative (C3I) with the goal of implementing sustainable tobacco cessation care. This paper addresses the design, implementation and sustainability of an evidence-based tobacco treatment program at an NCI comprehensive cancer center using the RE-AIM framework. The Reach, Effectiveness, Adoption, Implementation, and Maintenance goals were achieved through a multidisciplinary collaboration that led to the successful expansion of an evidence-based, yet under-resources and under-utilized tobacco cessation program into an organization-wide program employing standardized electronic medical records (EMR) workflows, a tobacco registry, additional certified tobacco specialists, and a strong programmatic and evaluation team including clinical and population science leadership. The program optimization led to a ten-fold increase in patients seen for tobacco cessation services and a 31% 7-day point prevalence of cessation. This paper serves to provide both a case study and guide on how to use RE-AIM to evaluate other cancer education programs and perhaps other areas of education, including vaping, nicotine replacement therapy, and relapse. This study highlights the importance of tobacco treatment as part of comprehensive cancer care and serves as a case-study for the usage of RE-AIM to design, implement, and evaluate health education programs.