Key takeaways:

• A smoking cessation program could prevent thousands of deaths of people with cancer if implemented nationwide.
• It also could save billions in healthcare costs.

Implementation of a nationwide tobacco cessation program could save more than 60,000 lives and $12 billion in healthcare costs in 10 years.

A dynamic evaluation of the Tobacco Research and Treatment Program at The University of Texas MD Anderson Cancer Center also showed that if healthcare institutions across the country established the same protocols, nearly 290,000 life years could be gained over a decade.

Data derived from Kypriotakis G, et al. JCO Oncol Pract. 2026;doi:10.1200/OP-26-00175.

“Tobacco treatment should be perceived as cancer treatment,” George Kypriotakis, PhD, assistant professor in the department of behavioral science at UT MD Anderson, told Healio. “Tobacco use should be treated like you treat cholesterol. Clinicians should treat tobacco as a serious vital sign that, if you modify it, if you offer a treatment and the patient changes, you’re going to see big outcomes in terms of their health.”

‘Quitting is extremely difficult’

More than 2 million new malignancies will be diagnosed in 2026 and approximately 625,000 individuals will die of cancer, according to American Cancer Society’s Cancer Statistics 2026 report.

Healio previously reported tobacco accounted for 15% of 18.7 million global cancer cases in 2022.

In the U.S, smoking causes roughly 30% of cancer deaths, according to study background.

“Everybody knows that smoking is bad for you. The problem is that quitting is extremely difficult,” Francesco Versace, PhD, professor in the department of behavioral science at UT MD Anderson, told Healio.

Healio previously reported individuals who quit smoking after receiving a cancer diagnosis halve their mortality risk compared with those who continued to smoke.

The Tobacco Research and Treatment Program at MD Anderson offers cessation services to patients with cancer who actively smoke or recently quit. The program provides counseling in person, over the phone or virtually, as well as medication at no cost to the patient.

Kypriotakis and colleagues previously published data on the program, which showed nearly 45% of participants achieved 7-day abstinence at 9 months and that cessation at 3, 6 and 9 months significantly improved survival.

Additionally, abstinence at 3 months reduced median healthcare costs by more than $1,000 per patient within the first 3 months after quitting.

Based on these findings, Kypriotakis and colleagues investigated potential healthcare savings if the Tobacco Research and Treatment Program were implemented across the U.S.

They developed a dynamic survival and cost model based on 18 million cancer survivors with a smoking prevalence rate of 11.4%, and 2 million new cases per year with 15% smoking prevalence.

The base scenario assumed 50% program reach, 45% abstinence, a 21% lower risk for death for those who quit compared with continuing smokers, and 20% annual relapse.

Survival gains and healthcare savings at 10 years served as primary endpoints.

The researchers also published OncoQuit, a free interactive web tool that allows institutions to run the model with their own numbers and project their expected survival gains and cost savings.

‘Large’ benefit

The base scenario showed the program prevented 66,462 deaths over 10 years and gained 287,446 life years.

“I didn’t expect the benefit to be so large,” Kypriotakis said.

In the first year alone, 9,011 deaths would be avoided. The program would prevent 41,136 deaths within 5 years.

The program also would save $12.32 billion in healthcare costs over 10 years, including $2.03 billion in the first year and $7.84 billion within 5 years.

“Quitting smoking really makes an immediate impact,” Versace said.

Increasing reach to 60% and abstinence to 50% in the model resulted in 88,615 lives saved, 383,262 life years gained, and $16.42 billion in cost savings over 10 years.

Increasing reach to 80% and quit rates to 60% would prevent 141,785 deaths, gain 613,219 life years and save $26.28 billion.

“We also tested the Cancer Center Cessation Initiative, a huge nationwide initiative, which has about 28% reach instead of 50%, and about 22% abstinence instead of 45%,” Kypriotakis said. “In the first 10 years, you save about $3.4 billion instead of $12 billion, and about 18,000 lives instead of 66,000. You still have very strong benefits.”

With base scenario numbers, the program had a maximum break-even cost per participant of approximately $5,255.

“If you quit smoking, your wounds heal faster. You’re less subject to infections. If you get an infection in the hospital, the hospital has to pay for that treatment,” Versace said. “If quitting makes you heal faster, you have savings there.”

“On average, tobacco treatment programs spend about $2,000 per patient," Kypriotakis added. "The model puts the break-even point above $5,000, so a hospital running a program like this would effectively gain about $3,000 per person.”

Researchers acknowledged study limitations, including combining survival numbers across cancer types for the model.

Ask the question

On Jan. 1, American College of Surgeons Commission on Cancer Standard 5.9: Tobacco Treatment for Patients with Cancer, went into effect.

The standard required accredited cancer programs to institute protocols to achieve at least 90% tobacco screening rates and at least 80% treatment/referrals for current smokers.

Kypriotakis and Versace emphasized these data support aggressive implementation of tobacco cessation initiatives into practice.

“The next step is policy. These findings give payers like the Centers for Medicare and Medicaid Services a clear case: here are the savings, here is the break-even. Spending money on these programs saves money," Kypriotakis said. "Instead of individual institutions carrying the burden of paying for these programs, they could be reimbursed.”

Future research also should evaluate healthcare utilization and costs associated with other smoking types, including e-cigarettes and vaping.

“Smoking [prevalence] is going to go down, but how will the role of these alternative tobacco products and new tobacco product combinations play out?” Kypriotakis asked. “Will people switch? Will they become dual users? What will be the effect of completely switching to a different tobacco product? What will be the effect if you remain a dual user? We do not yet fully understand those outcomes. That will be a challenge for the next few years.”

For now, Kypriotakis implored all clinicians to take the same first step with each of their patients: “Ask every patient if they smoke.”

For more information:

George Kypriotakis, PhD, can be reached at gkypriotakis@mdanderson.org.

Francesco Versace, PhD, can be reached at fversace@mdanderson.org.