Abstract 2433: The NCI Cancer Center Cessation Initiative (C3I): Characteristics and reach of tobacco treatment programs among NCI-designated cancer centers in the C3I

Abstract Background: The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications.Methods: We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one six-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs.Results: Total monthly operating costs across funded centers ranged from $6,453 to $20,751. The largest operating cost category was personnel ($4,122-$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly cost ranges for other categories were: medications ($17-$573), materials ($6-$435), training ($96-$516), technology ($171-$2,759), and equipment ($10-$620). Cost-per-participant ranged from $70 to $3,500 (median, $537) and cost-per-quit ranged from $330 to $9,799 (median, $2,699) with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications.Conclusions: Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.

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Mixed-methods economic evaluation of the implementation of tobacco treatment programs in National Cancer Institute-designated cancer centers

Implementation Science Communications ◽

10.1186/s43058-021-00144-7 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Ramzi G. Salloum ◽

Heather D’Angelo ◽

Ryan P. Theis ◽

Betsy Rolland ◽

Sarah Hohl ◽

...

Keyword(s):

Mixed Methods ◽

Operating Costs ◽

System Level ◽

Treatment Programs ◽

Cancer Centers ◽

Additional Information ◽

Tobacco Treatment ◽

Wide Range ◽

Implementation Costs ◽

Program Components

Abstract Background The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications. Methods We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one 6-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs. Results Median total monthly operating costs across funded centers were $11,045 (range: $5129–$20,751). The largest median operating cost category was personnel ($10,307; range: $4122–$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly (non-zero) cost ranges for other categories were medications ($17–$573), materials ($6–$435), training ($96–$516), technology ($171–$2759), and equipment ($10–$620). Median cost-per-participant was $466 (range: $70–$2093) and cost-per-quit was $2688 (range: $330–$9628), with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications. Conclusions Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.

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Sustainability of Tobacco Treatment Programs in the Cancer Center Cessation Initiative

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2021.7093 ◽

2021 ◽

Vol 19 (Suppl_1) ◽

pp. S16-S20

Author(s):

_ _

Keyword(s):

Case Studies ◽

Tobacco Use ◽

Cancer Care ◽

Working Group ◽

Sustainability Assessment ◽

Implementation Strategies ◽

Treatment Programs ◽

Cancer Center ◽

Program Outcomes ◽

Tobacco Treatment

The NCI’s Cancer Center Cessation Initiative (C3I) has a specific objective of helping cancer centers develop and implement sustainable programs to routinely address tobacco cessation with patients. Sustaining tobacco treatment programs requires the maintenance of (1) core program components, (2) ongoing implementation strategies, and (3) program outcomes evaluation. NCI funding of C3I included a commitment of resources toward sustainability. This article presents case studies to illustrate key strategies in developing sustainability capacity across 4 C3I-funded sites. Case studies are organized according to the domains of sustainability capacity defined in the Clinical Sustainability Assessment Tool (CSAT). We also describe the C3I Sustainability Working Group agenda to make scientific and practical contributions in 3 areas: (1) demonstrating the value of tobacco use treatment in cancer care, (2) identifying implementation strategies to support sustainability, and (3) providing evidence to inform policy changes that support the prioritization and financing of tobacco use treatment. By advancing this agenda, the Sustainability Working Group can play an active role in advancing and disseminating knowledge for tobacco treatment program sustainability to assist cancer care organizations in addressing tobacco use by patients with cancer within and beyond C3I.

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Mixed-methods Economic Evaluation of the Implementation of Tobacco Treatment Programs in National Cancer Institute-designated Cancer Centers

10.21203/rs.3.rs-149148/v1 ◽

2021 ◽

Author(s):

Ramzi G. Salloum ◽

Heather D'Angelo ◽

Ryan Theis ◽

Betsy Rolland ◽

Sarah Hohl ◽

...

Keyword(s):

Mixed Methods ◽

Operating Costs ◽

System Level ◽

Treatment Programs ◽

Cancer Centers ◽

Additional Information ◽

Tobacco Treatment ◽

Wide Range ◽

Implementation Costs ◽

Program Components

Abstract Background: The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications.Methods: We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one six-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs.Results: Total monthly operating costs across funded centers ranged from $6,453 to $20,751. The largest operating cost category was personnel ($4,122-$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly cost ranges for other categories were: medications ($17-$573), materials ($6-$435), training ($96-$516), technology ($171-$2,759), and equipment ($10-$620). Cost-per-participant ranged from $70 to $3,500 (median, $537) and cost-per-quit ranged from $330 to $9,799 (median, $2,699) with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications.Conclusions: Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.

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The Emergence of a Sustainable Tobacco Treatment Program across the Cancer Care Continuum: A Systems Approach for Implementation at the University of California Davis Comprehensive Cancer Center

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093241 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3241 ◽

Cited By ~ 1

Author(s):

Elisa K. Tong ◽

Terri Wolf ◽

David T. Cooke ◽

Nathan Fairman ◽

Moon S. Chen

Keyword(s):

Treatment Program ◽

Cancer Care ◽

University Of California ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cancer Centers ◽

Care Continuum ◽

Tobacco Treatment ◽

Cancer Care Continuum ◽

The University

Tobacco treatment is increasingly recognized as important to cancer care, but few cancer centers have implemented sustainable tobacco treatment programs. The University of California Davis Comprehensive Cancer Center (UCD CCC) was funded to integrate tobacco treatment into cancer care. Lessons learned from the UCD CCC are illustrated across a systems framework with the Cancer Care Continuum and by applying constructs from the Consolidated Framework for Implementation Research. Findings demonstrate different motivational drivers for the cancer center and the broader health system. Implementation readiness across the domains of the Cancer Care Continuum with clinical entities was more mature in the Prevention domain, but Screening, Diagnosis, Treatment, and Survivorship domains demonstrated less implementation readiness despite leadership engagement. Over a two-year implementation process, the UCD CCC focused on enhancing information and knowledge sharing within the treatment domain with the support of the cancer committee infrastructure, while identifying available resources and adapting workflows for various cancer care service lines. The UCD CCC findings, while it may not be generalizable to all cancer centers, demonstrate the application of conceptual frameworks to accelerate implementation for a sustainable tobacco treatment program. Key common elements that may be shared across oncology settings include a state quitline for an adaptable intervention, cancer committees for outer/inner setting infrastructure, tobacco quality metrics for data reporting, and non-physician staff for integrated services.

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Tobacco Treatment Program Implementation at NCI Cancer Centers: Progress of the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

Cancer Prevention Research ◽

10.1158/1940-6207.capr-19-0182 ◽

2019 ◽

Vol 12 (11) ◽

pp. 735-740 ◽

Cited By ~ 6

Author(s):

Heather D'Angelo ◽

Betsy Rolland ◽

Robert Adsit ◽

Timothy B. Baker ◽

Marika Rosenblum ◽

...

Keyword(s):

Treatment Program ◽

Program Implementation ◽

Cancer Center ◽

Cancer Centers ◽

Tobacco Treatment

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Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up

Sustainability ◽

10.3390/su13137216 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7216

Author(s):

Paul H. Park ◽

Cyprien Shyirambere ◽

Fred Kateera ◽

Neil Gupta ◽

Christian Rusangwa ◽

...

Keyword(s):

Capacity Building ◽

Scale Up ◽

Implementation Strategies ◽

Sub Saharan Africa ◽

Essential Medicines ◽

Cancer Center ◽

Health Coverage ◽

Cancer Centers ◽

Implementation Approach ◽

Single Cancer

Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

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