An Implementation Trial to Improve Tobacco Treatment for Cancer Patients: Patient Preferences, Treatment Acceptability and Effectiveness
Abstract
:1. Introduction
2. Materials and Methods
2.1. Provider and Staff Training
2.2. Participants and Setting
2.3. Recruitment
2.4. Treatment
2.4.1. External Tobacco Treatment Services (PhoneQuit, GroupQuit)
2.4.2. SmartQuit
2.5. Measures
2.5.1. Patient Exit Interviews (PEIs)
2.5.2. Follow-Up Telephone Survey
2.6. Statistical Analysis
3. Results
3.1. Participants
3.2. Reach and Tobacco Treatment Choice
3.3. Smoking Outcomes
3.4. Treatment Use and Acceptability
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Salloum, R.G.; Huo, J.; Lee, J.H.; Lee, J.; Dallery, J.; George, T.; Warren, G. Tobacco and E-cigarette use among cancer survivors in the United States. PLoS ONE 2019, 14, e0226110. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Warren, G.W.; Kasza, K.A.; Reid, M.E.; Cummings, K.M.; Marshall, J.R. Smoking at diagnosis and survival in cancer patients. Int. J. Cancer 2013, 132, 401–410. [Google Scholar] [CrossRef] [PubMed]
- Kenfield, S.A.; Stampfer, M.J.; Chan, J.M.; Giovannucci, E. Smoking and prostate cancer survival and recurrence. JAMA 2011, 305, 2548–2555. [Google Scholar] [CrossRef] [PubMed]
- Duffy, S.A.; Taylor, J.M.; Terrell, J.E.; Islam, M.; Li, Y.; Fowler, K.E.; Wolf, G.T.; Teknos, T.N. Interleukin-6 predicts recurrence and survival among head and neck cancer patients. Cancer 2008, 113, 750–757. [Google Scholar] [CrossRef]
- Gajdos, C.; Hawn, M.T.; Campagna, E.J.; Henderson, W.G.; Singh, J.A.; Houston, T. Adverse effects of smoking on postoperative outcomes in cancer patients. Ann. Surg. Oncol. 2012, 19, 1430–1438. [Google Scholar] [CrossRef]
- Mason, D.P.; Subramanian, S.; Nowicki, E.R.; Grab, J.D.; Murthy, S.C.; Rice, T.W.; Blackstone, E.H. Impact of smoking cessation before resection of lung cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database study. Ann. Thorac. Surg. 2009, 88, 362–371; discussion 370–371. [Google Scholar] [CrossRef]
- Johnson, B.E.; Cortazar, P.; Chute, J.P. Second lung cancers in patients successfully treated for lung cancer. Semin. Oncol. 1997, 24, 492–499. [Google Scholar]
- Do, K.A.; Johnson, M.M.; Lee, J.J.; Wu, X.F.; Dong, Q.; Hong, W.K.; Khuri, F.R.; Spitz, M.R. Longitudinal study of smoking patterns in relation to the development of smoking-related secondary primary tumors in patients with upper aerodigestive tract malignancies. Cancer 2004, 101, 2837–2842. [Google Scholar] [CrossRef]
- Stead, L.F.; Koilpillai, P.; Fanshawe, T.R.; Lancaster, T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst. Rev. 2016, 3, CD008286. [Google Scholar] [CrossRef]
- Fiore, M.C.; Bailey, W.C.; Cohen, S.J.; Dorfman, S.F.; Goldstein, M.G.; Gritz, E.R.; Heyman, R.B.; Jaen, C.R.; Kottke, T.E.; Lando, H.A. Treating Tobacco Use and Dependence: Clinical Practice Guideline; US Department of Health and Human Services, Public Health Service: Rockville, MD, USA, 2000.
- Simmons, V.N.; Litvin, E.B.; Jacobsen, P.B.; Patel, R.D.; McCaffrey, J.C.; Oliver, J.A.; Sutton, S.K.; Brandon, T.H. Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer 2013, 119, 1420–1427. [Google Scholar] [CrossRef] [Green Version]
- Guimond, A.J.; Croteau, V.A.; Savard, M.H.; Bernard, P.; Ivers, H.; Savard, J. Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: An 18-Month Observational Study. Ann. Behav. Med. 2017, 51, 117–127. [Google Scholar] [CrossRef] [PubMed]
- Ostroff, J.S.; Jacobsen, P.B.; Moadel, A.B.; Spiro, R.H.; Shah, J.P.; Strong, E.W.; Kraus, D.H.; Schantz, S.P. Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer 1995, 75, 569–576. [Google Scholar] [CrossRef]
- McBride, C.M.; Ostroff, J.S. Teachable moments for promoting smoking cessation: The context of cancer care and survivorship. Cancer Control 2003, 10, 325–333. [Google Scholar] [CrossRef] [PubMed]
- Schnoll, R.A.; Malstrom, M.; James, C.; Rothman, R.L.; Miller, S.M.; Ridge, J.A.; Movsas, B.; Unger, M.; Langer, C.; Goldberg, M. Correlates of tobacco use among smokers and recent quitters diagnosed with cancer. Patient Educ. Couns. 2002, 46, 137–145. [Google Scholar] [CrossRef]
- Chapple, A.; Ziebland, S.; McPherson, A. Stigma, shame, and blame experienced by patients with lung cancer: Qualitative study. BMJ 2004, 328, 1470. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Aigner, C.J.; Cinciripini, P.M.; Anderson, K.O.; Baum, G.P.; Gritz, E.R.; Lam, C.Y. The Association of Pain With Smoking and Quit Attempts in an Electronic Diary Study of Cancer Patients Trying to Quit. Nicotine Tob. Res. 2016, 18, 1449–1455. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Morgan, G.; Schnoll, R.A.; Alfano, C.M.; Evans, S.E.; Goldstein, A.; Ostroff, J.; Park, E.R.; Sarna, L.; Cox, L.S. National cancer institute conference on treating tobacco dependence at cancer centers. J. Oncol. Pract. 2011, 7, 178–182. [Google Scholar] [CrossRef]
- Fiore, M.C.; D’Angelo, H.; Baker, T. Effective Cessation Treatment for Patients With Cancer Who Smoke-The Fourth Pillar of Cancer Care. JAMA Netw. Open 2019, 2, e1912264. [Google Scholar] [CrossRef] [Green Version]
- Cinciripini, P.M.; Karam-Hage, M.; Kypriotakis, G.; Robinson, J.D.; Rabius, V.; Beneventi, D.; Minnix, J.A.; Blalock, J.A. Association of a Comprehensive Smoking Cessation Program With Smoking Abstinence Among Patients With Cancer. JAMA Netw. Open 2019, 2, e1912251. [Google Scholar] [CrossRef] [Green Version]
- Toll, B.A.; Brandon, T.H.; Gritz, E.R.; Warren, G.W.; Herbst, R.S. Assessing tobacco use by cancer patients and facilitating cessation: An American Association for Cancer Research policy statement. Clin. Cancer Res. 2013, 19, 1941–1948. [Google Scholar] [CrossRef] [Green Version]
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Available online: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp (accessed on 27 June 2019).
- Warren, G.W.; Marshall, J.R.; Cummings, K.M.; Toll, B.A.; Gritz, E.R.; Hutson, A.; Dibaj, S.; Herbst, R.; Mulshine, J.L.; Hanna, N.; et al. Addressing tobacco use in patients with cancer: A survey of American Society of Clinical Oncology members. J. Oncol. Pract. 2013, 9, 258–262. [Google Scholar] [CrossRef] [PubMed]
- Warren, G.W.; Marshall, J.R.; Cummings, K.M.; Zevon, M.A.; Reed, R.; Hysert, P.; Mahoney, M.C.; Hyland, A.J.; Nwogu, C.; Demmy, T.; et al. Automated tobacco assessment and cessation support for cancer patients. Cancer 2014, 120, 562–569. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- D’Angelo, H.; Rolland, B.; Adsit, R.; Baker, T.B.; Rosenblum, M.; Pauk, D.; Morgan, G.D.; Fiore, M.C. Tobacco Treatment Program Implementation at NCI Cancer Centers: Progress of the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative. Cancer Prev. Res. 2019, 12, 735–740. [Google Scholar] [CrossRef] [Green Version]
- Warren, G.W.; Dibaj, S.; Hutson, A.; Cummings, K.M.; Dresler, C.; Marshall, J.R. Identifying Targeted Strategies to Improve Smoking Cessation Support for Cancer Patients. J. Thorac. Oncol. 2015, 10, 1532–1537. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Warren, G.W.; Marshall, J.R.; Cummings, K.M.; Toll, B.; Gritz, E.R.; Hutson, A.; Dibaj, S.; Herbst, R.; Dresler, C.; Control, I.T.; et al. Practice patterns and perceptions of thoracic oncology providers on tobacco use and cessation in cancer patients. J. Thorac. Oncol. 2013, 8, 543–548. [Google Scholar] [CrossRef] [Green Version]
- American Society of Clinical Oncology. Tobacco Cessation Guide for Oncology Providers; American Society of Clinical Oncology: Alexandria, VA, USA, 2012. [Google Scholar]
- Dallery, J.; Raiff, B.R.; Grabinski, M.J. Internet-based contingency management to promote smoking cessation: A randomized controlled study. J. Appl. Behav. Anal. 2013, 46, 750–764. [Google Scholar] [CrossRef]
- Pbert, L.; Adams, A.; Quirk, M.; Hebert, J.R.; Ockene, J.K.; Luippold, R.S. The patient exit interview as an assessment of physician-delivered smoking intervention: A validation study. Health Psychol. 1999, 18, 183–188. [Google Scholar] [CrossRef]
- Hitz, M.M.; Conway, P.G.; Palcher, J.A.; McCarty, C.A. Using PhenX toolkit measures and other tools to assess urban/rural differences in health behaviors: Recruitment methods and outcomes. BMC Res. Notes 2014, 7, 847. [Google Scholar] [CrossRef] [Green Version]
- Hughes, J.R.; Keely, J.P.; Niaura, R.S.; Ossip-Klein, D.J.; Richmond, R.L.; Swan, G.E. Measures of abstinence in clinical trials: Issues and recommendations. Nicotine Tob. Res. 2003, 5, 13–25. [Google Scholar] [CrossRef]
- Javors, M.A.; Hatch, J.P.; Lamb, R.J. Cut-off levels for breath carbon monoxide as a marker for cigarette smoking. Addiction 2005, 100, 159–167. [Google Scholar] [CrossRef]
- IBM Corp. IBM SPSS Statistics for Windows, Version 25.0; IBM Corp: Armonk, NY, USA, 2017. [Google Scholar]
- Houston, T.K.; Sadasivam, R.S.; Allison, J.J.; Ash, A.S.; Ray, M.N.; English, T.M.; Hogan, T.P.; Ford, D.E. Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: A national hybrid type 2 implementation study. Implement. Sci. 2015, 10, 154. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Borland, R.; Balmford, J.; Bishop, N.; Segan, C.; Piterman, L.; McKay-Brown, L.; Kirby, C.; Tasker, C. In-practice management versus quitline referral for enhancing smoking cessation in general practice: A cluster randomized trial. Fam. Pract. 2008, 25, 382–389. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- An, L.C.; Bluhm, J.H.; Foldes, S.S.; Alesci, N.L.; Klatt, C.M.; Center, B.A.; Nersesian, W.S.; Larson, M.E.; Ahluwalia, J.S.; Manley, M.W. A randomized trial of a pay-for-performance program targeting clinician referral to a state tobacco quitline. Arch. Intern. Med. 2008, 168, 1993–1999. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nayan, S.; Gupta, M.K.; Strychowsky, J.E.; Sommer, D.D. Smoking cessation interventions and cessation rates in the oncology population: An updated systematic review and meta-analysis. Otolaryngol. Head Neck Surg. 2013, 149, 200–211. [Google Scholar] [CrossRef] [PubMed]
- Pew Research Center. Tech. Adoption Climbs Among Older Adults; Pew Research Center: Washington, DC, USA, 2017. [Google Scholar]
- Potdar, R.; Thomas, A.; DiMeglio, M.; Mohiuddin, K.; Djibo, D.A.; Laudanski, K.; Dourado, C.; Leighton, J.; Ford, J.G. Access to internet, smartphone usage, and acceptability of mobile health technology among cancer patients. Support. Care Cancer 2020. [Google Scholar] [CrossRef]
Characteristics | GroupQuit (n = 14) | PhoneQuit (n = 39) | SmartQuit (n = 37) | Total (n = 90) |
---|---|---|---|---|
Age (mean, SD) | 57.3 (6.9) | 60.6 (1.2) | 55.5 (13.1) | 58.0 (10.2) |
Gender | ||||
Male | 4 (28.6%) | 20 (51.3%) | 16 (43.2%) | 40 (44.4%) |
Female | 10 (71.4%) | 19 (48.7%) | 21 (56.8%) | 50 (55.5%) |
Race2 | ||||
White | 9 (64.3%) | 30 (76.9%) | 29 (78.4%) | 68 (75.6%) |
Black/African American | 4 (28.6%) | 8 (20.5%) | 5 (13.5%) | 17 (18.9%) |
Other | 3 (17.0%) | 2 (5.5%) | 4 (10.8%) | 9 (10.0%) |
Ethnicity | ||||
Hispanic | 1 (7.1%) | 0 (0.0%) | 1 (2.7%) | 2 (2.2%) |
Non-Hispanic | 13 (92.9%) | 39 (100.0%) | 36 (97.3%) | 88 (97.8%) |
Marital status | ||||
Married or cohabitating | 6 (42.9%) | 24 (61.5%) | 15 (40.5%) | 45 (50.0%) |
Not married or cohabitating | 8 (57.1%) | 15 (39.5%) | 22 (59.4%) | 45 (50.0%) |
Rurality a | ||||
Urban | 8 (57.1%) | 28 (71.8%) | 26 (70.3%) | 62 (68.9%) |
Rural | 6 (42.9%) | 11 (28.2%) | 11 (29.7%) | 28 (31.1%) |
Cigarette smoking frequency | ||||
Every day | 13 (92.9%) | 30 (76.9%) | 34 (91.9%) | 77 (85.6%) |
Some days | 0 (0.0%) | 7 (17.9%) | 3 (8.1%) | 10 (11.1%) |
E-cigarette use frequency | ||||
Every day | 1 (7.1%) | 1 (2.6%) | 4 (10.8%) | 6 (6.7%) |
Some days | 1 (7.1%) | 10 (25.6%) | 6 (16.2%) | 17 (18.9%) |
Not at all | 11 (78.6%) | 27 (69.2%) | 27 (73.0%) | 65 (72.2%) |
Cigarettes/day (mean, SD) | 20.1 (15.1) | 12.3 (8.5) | 13.8 (12.1) | 14.2 (11.5) |
Age of smoking initiation (mean, SD) | 21.0 (8.1) | 18.9 (6.5) | 16.2 (6.4) | 17.0 (8.0) |
PEI composite score (1–10) | 6.9 (2.9) | 7.2 (2.9) | 7.7 (2.6) | 7.4 (2.7) |
Cancer diagnosis | ||||
Past week | 1 (7.1%) | 2 (5.1%) | 2 (5.4%) | 5 (5.6%) |
Past month | 0 (0.0%) | 4 (10.3%) | 5 (13.5%) | 9 (10.0%) |
Past 1–3 months | 3 (21.4%) | 7 (17.9%) | 4 (10.8%) | 14 (15.6%) |
Past 4–6 months | 3 (21.4%) | 7 (17.9%) | 7 (18.9%) | 17 (18.9%) |
Past 7–12 months | 2 (14.3%) | 2 (5.1%) | 3 (8.1%) | 7 (7.8%) |
Over 12 months | 5 (35.7%) | 17 (43.6%) | 16 (43.2%) | 38 (42.2%) |
Cancer site b | ||||
Lung | 4 (28.6%) | 11 (28.2%) | 11 (29.7%) | 26 (28.9%) |
Head and neck | 5 (35.7%) | 8 (20.5%) | 20 (54.1%) | 33 (36.7%) |
Breast | 0 (0.0%) | 6 (15.4%) | 7 (18.9%) | 13 (14.4%) |
Gastrointestinal | 5 (35.7%) | 11 (28.2%) | 5 (13.5%) | 21 (23.3%) |
Thyroid | 0 (0.0%) | 2 (5.1%) | 0 (0.0%) | 2 (2.2%) |
Genitourinary | 2 (14.3%) | 7 (17.9%) | 3 (8.1%) | 12 (13.3%) |
Gynecologic | 2 (14.3%) | 1 (2.6%) | 2 (5.4%) | 5 (5.5%) |
Bone | 2 (14.3%) | 4 (10.3%) | 3 (8.1%) | 9 (10.0%) |
Brain | 2 (14.3%) | 4 (10.3%) | 1 (2.7%) | 7 (7.8%) |
Hematologic/Blood | 4 (28.6%) | 3 (7.7%) | 4 (10.8%) | 11 (12.2%) |
Other | 1 (7.1%) | 3 (7.7%) | 1 (2.7%) | 5 (5.6%) |
Clinic | Eligible Patients | Enrolled Patients |
---|---|---|
Medical Oncology | 227 | 53 (23.4%) |
Radiation Oncology | 230 | 25 (10.9%) |
ENT | 88 | 12 (13.6%) |
Total | 545 | 90 (16.5%) |
Reason for Treatment Choice | GroupQuit (n = 14) | PhoneQuit (n = 39) | SmartQuit (n = 37) |
---|---|---|---|
I think it would help me to quit | 10 (71.4%) | 18 (46.2%) | 17 (45.9%) |
I tried another method and it didn’t work out | 2 (14.3%) | 1 (2.6%) | 2 (5.4%) |
I know someone who is doing/has done the program | 1 (7.1%) | 0 (0.0%) | 1 (2.7%) |
I don’t have a smartphone | 3 (21.4%) | 7 (17.9%) | -- |
I would like having the group support | 8 (57.1%) | -- | -- |
I would rather talk to someone in-person | 8 (57.1%) | -- | -- |
It would be more convenient for me | -- | 26 (66.7%) | 21 (56.8%) |
I would like having the one-on-one support | -- | 8 (20.5%) | 13 (35.1%) |
I would rather talk to someone on the phone | -- | 15 (38.5%) | 15 (40.5%) |
I would like the fact that I can do it from home | -- | 26 (66.7%) | 21 (56.8%) |
I would like the video interaction with the counselor | -- | -- | 8 (21.6%) |
Other | 2 (14.3%) | 1 (2.6%) | 3 (8.1%) |
GroupQuit (n = 5) | PhoneQuit (n = 18) | SmartQuit (n = 12) | Total (n = 35) | |
---|---|---|---|---|
Treatment utilization | ||||
Received treatment | 3 (60.0%) | 9 (50.0%) | 7 (58.3%) | 19 (54.3%) |
No tobacco treatment | 2 (40.0%) | 9 (50.0%) | 5 (41.7%) | 16 (45.7%) |
7-day abstinence | ||||
Among patients completing follow-up (CCA) (n = 35) | 2 (40.0%) | 3 (16.7%) | 2 (28.6%) | 7 (20.0%) |
Received treatment | 2 (40.0%) | 2 (11.1%) | 1 (8.3%) | 5 (14.3%) |
No treatment | 0 (0.0%) | 1 (5.6%) | 1 (8.3%) | 2 (5.7%) |
Among all patients (ITT) (n = 90) a | 2 (14.3%) | 3 (7.7%) | 2 (5.4%) | 7 (7.8%) |
Mean change in cigarettes/day (SD) | −12.3 (7.5) | −5.0 (6.3) | −4.7 (13.7) | −5.9 (8.9) |
GroupQuit (n = 2) M (SD) | PhoneQuit (n = 11) M (SD) | SmartQuit (n = 4) M (SD) | |
---|---|---|---|
1. How interesting was the tobacco cessation treatment that you received? | 8 (1.4) | 4.0 (2.6) | 9.25 (1.5) |
2. How useful was the treatment that you received from this program? | 4.5 (3.5) | 6.2 (2.6) | 8.75 (2.5) |
3. How much new information did you learn as a result of the treatment that you received from this program? | 3.5 (4.6) | 4.7 (2.6) | 8.5 (3.0) |
4. How easy to understand was the treatment that you received from this program? | 5.0 (7.0) | 8.8 (2.0) | 8.6 (2.5) |
5. How satisfied were you with the treatment you received from this program? | 8.5 (2.1) | 6.7 (2.3) | 10.0 (0.0) |
6. How did this treatment compare with other treatments you have had for smoking cessation in the past? | 0 (0.0) | 5.0 (4.1) | 8.6 (2.5) |
7. How easily available was this program to you compared to other treatments you have had for smoking cessation in the past? | 3.5 (5.0) | 7.0 (4.0) | 8.5 (2.4) |
8. To what extent did the content of this treatment meet your specific needs compared to other treatments you have had for smoking cessation in the past? | 3.5 (5.0) | 6.0 (3.1) | 8.5 (2.4) |
9. To what extent were you able to learn new information that was based on your own personal needs? | 4.5 (6.4) | 5.8 (3.7) | 7.0 (3.5) |
10. To what extent were you concerned about electronic information (for example, privacy issues, sending information over the internet, etc.) as part of treatment? a | 10.0 (0.0) | 10.0 (0.0) | 8.3 (2.4) |
11. To what extent did you want more person-to-person help as part of this treatment? a | 7.5 (3.5) | 5.2 (4.2) | 3.2 (4.7) |
12. How helpful was the treatment in achieving your goals? | 3.5 (5.0) | 6.2 (3.6) | 7.25 (3.2) |
13. How easy to use was this treatment? | 8.5 (.7) | 7.5 (3.9) | 7.5 (5) |
14. How flexible was the treatment in terms of when you could access it? | 8.0 (1.4) | 8.2 (2.4) | 10 (0.0) |
15. Did the treatment help you learn and practice new skills in risky situations? | 3.5 (5.0) | 4.3 (4.8) | 5.8 (5.1) |
16. How likely is it that you would recommend this treatment to a friend? | 5.0 (7.1) | 7.7 (3.9) | 10 (0.0) |
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LeLaurin, J.H.; Dallery, J.; Silver, N.L.; Markham, M.-J.; Theis, R.P.; Chetram, D.K.; Staras, S.A.; Gurka, M.J.; Warren, G.W.; Salloum, R.G. An Implementation Trial to Improve Tobacco Treatment for Cancer Patients: Patient Preferences, Treatment Acceptability and Effectiveness. Int. J. Environ. Res. Public Health 2020, 17, 2280. https://doi.org/10.3390/ijerph17072280
LeLaurin JH, Dallery J, Silver NL, Markham M-J, Theis RP, Chetram DK, Staras SA, Gurka MJ, Warren GW, Salloum RG. An Implementation Trial to Improve Tobacco Treatment for Cancer Patients: Patient Preferences, Treatment Acceptability and Effectiveness. International Journal of Environmental Research and Public Health. 2020; 17(7):2280. https://doi.org/10.3390/ijerph17072280
Chicago/Turabian StyleLeLaurin, Jennifer H., Jesse Dallery, Natalie L. Silver, Merry-Jennifer Markham, Ryan P. Theis, Deandra K. Chetram, Stephanie A. Staras, Matthew J. Gurka, Graham W. Warren, and Ramzi G. Salloum. 2020. "An Implementation Trial to Improve Tobacco Treatment for Cancer Patients: Patient Preferences, Treatment Acceptability and Effectiveness" International Journal of Environmental Research and Public Health 17, no. 7: 2280. https://doi.org/10.3390/ijerph17072280
APA StyleLeLaurin, J. H., Dallery, J., Silver, N. L., Markham, M. -J., Theis, R. P., Chetram, D. K., Staras, S. A., Gurka, M. J., Warren, G. W., & Salloum, R. G. (2020). An Implementation Trial to Improve Tobacco Treatment for Cancer Patients: Patient Preferences, Treatment Acceptability and Effectiveness. International Journal of Environmental Research and Public Health, 17(7), 2280. https://doi.org/10.3390/ijerph17072280