Tobacco cessation prescription utilization rates among Veterans with cancer who smoke
Abstract: Tobacco use is the single most important modifiable risk factor in patients undergoing cancer treatment. The VHA offers evidence-based tobacco cessation treatment, with annual “Clinical Reminders” in the electronic health record (EHR) to standardize prescribing, and also provides high-quality cancer treatment. After obtaining Institutional Review Board approvals, we conducted a retrospective cohort study using EHR data from the VHA Corporate Data Warehouse. RStudio 2022.07.2/R version 4.1.2 was used for analyses. Using data from 2015 to 2021, we examined tobacco cessation prescriptions among Veteran VHA patients with cancer who smoke. Among N = 35,330 VHA patients diagnosed with cancer in 2019, 8091(22.9%) were current smokers at the time of cancer diagnosis (Fig. 1). Among patients who were current smokers, 43.8% (N = 3545) received at least one cessation medication prescription in the 2 years following cancer diagnosis. This analysis is the first to evaluate cessation medication receipt among VHA patients with cancer. VHA cancer patients are receiving cessation pharmacotherapy at a higher rate than is commonly observed in non-VHA clinics, likely due to universal access to free cessation treatment and implementation of tobacco clinical reminders across all VHA facilities. Nonetheless, results reveal room for improvement in cessation prescribing within VHA. Limitations include lack of information about quit intention/readiness or cessation outcomes; inability to exclude bupropion for depression; non-inclusion of smokeless tobacco use or over-the-counter NRT; lack of information about medical contraindications for cessation pharmacotherapy; potential unmeasured impacts of COVID-19 pandemic on prescribing; and inability to verify diagnostic, treatment, or demographic information beyond what is documented in EHR. Results support integrating tobacco cessation treatment into VHA oncology and primary care for cancer patients. Targeted interventions for Veterans with cancer in high-risk categories for undertreatment may reduce health disparities.