Childhood cancer survivors represent a large and rapidly increasing group due to successes in cancer therapy over the last several decades. However, the treatments for childhood cancers tend to damage vital organs, and there is an increased risk of second cancers in childhood cancer survivors who may already have an innate susceptibility to neoplasia. Therefore, it is extremely important that preventable risk factors of cardiac, pulmonary, neoplastic, and other major diseases be minimized among this high-risk population. Interventions to reduce smoking prevalence among childhood cancer survivors are a critical component of efforts to reduce their preventable cancer morbidity and mortality. We recently completed Partnership for Health (PFH), the first large-scale smoking cessation intervention study to be conducted with childhood cancer survivors. The PFH intervention yielded a doubling of quit rates in the intervention group, compared to a self-help control group. PFH was conducted in the context of the Childhood Cancer Survivor Study (CCSS), a large epidemiologic cohort study of the late effects of treatment for childhood cancers. CCSS is a consortium of 22 cancer centers that enrolled over 14,000 patients into this surveillance program. The CCSS institutions are all members of the Children's Oncology Group (COG), which is our partner in this dissemination effort. As a result of the success of PFH, we plan to disseminate the intervention directly to the 235 COG institutions that provide on-going follow-up to the majority of childhood cancer survivors in the US and Canada. Our initial discussions with several COG members suggest that few of its member institutions currently offer smoking cessation services. The 235 COG institutions provide care to over 95% of North American children with cancer. The focus of this supplement will be on the process of dissemination of the PFH intervention to COG institutions, and the evaluation of the effectiveness of our dissemination efforts guided by a well-delineated theoretical framework. In addition to evaluating the relationship of organizational characteristics to program adoption, we will conduct a randomized control trial to determine whether providing assistance with the more labor-intensive aspects of implementation increases adoption and effective implementation. Outcomes include: intervention adoption (percent of cancer centers that adopt the program), quality of implementation (number of components implemented and level of implementation of each), and delivery of the intervention to survivors (number of survivors enrolled in the dissemination effort). COG's infrastructures and clinical trials network has resulted in dramatic improvements in cure rates for pediatric cancers. The proposed project will begin an effort to build on this success related to clinical therapeutic outcomes, and transfer it to cancer prevention outcomes.
