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Introduction: Unassisted attempts to quit tobacco are a well-established reason for quit failure. Nonetheless, many cancer patients prefer to make a quit attempt without using evidence-based tobacco treatment. This study aimed to understand the rationale that underlies cancer patients’ desire to quit tobacco without assistance and to track longitudinally the smoking cessation outcomes of patients with this preference. Method: In a mixed-methods, longitudinal study, 35 cancer patients who were current tobacco users and declined tobacco treatment because of the desire to quit on their own provided data via three questionnaires and 1-2 semi-structured interviews across 60 days. Participants were recruited from outpatient cancer clinics. Results: The sample was predominately White, non-Hispanic (85.71%), female (68.57%), unemployed due to disability (57.14%), and rural (54.29%). Key themes that emerged from the qualitative interviews were: self-reliance, willpower, perceived shame, social norms around unassisted quitting, and negative attitudes towards tobacco treatment. The most frequently endorsed barrier to tobacco treatment was “I know others who have quit without tobacco treatment” (82.86%, n = 29). During the study, participants reported smoking 12.20 ± 7.78 cigarettes per day on smoking days. Fourteen (43.67%) participants reported achieving 50% smoking reduction and 21.88% of participants achieved 3-day floating abstinence; none of these participants used treatment. Discussion: This study with cancer patients who use tobacco identified affective, cognitive, and personality factors related to quitting on one’s own, and social and systemic barriers to tobacco treatment use. Future interventions must address these factors to increase uptake of tobacco treatment in this population.

Smoking after cancer diagnosis is linked to cancer-specific and all-cause mortality among other adverse outcomes. Yet, 10-20% of U.S. cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a tobacco treatment program integrated within an NCI-designated cancer center. Participants consist of 26,365 patients seen at the cancer center during the first 18 months of implementation. The study is a retrospective chart review of patients’ tobacco use, and among current users, patients’ treatment referral response. Over 99% of patients were screened for tobacco use. Current use occurred in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among the 76.59% of current users who declined, the majority were “not ready to quit” or wanted to quit “on their own”. Multiple demographic and clinical variables were associated with tobacco use and treatment referral response outcomes. Despite cancer diagnosis presenting a “teachable moment” for tobacco cessation, many cancer patients may not be ready to quit. Clinically proven strategies to increase motivation, prompt quit attempts and encourage treatment use are warranted in cancer settings.