Objective: Continuing to smoke after a cancer diagnosis undermines prognosis. Yet, few trials have tested FDA-approved tobacco use medications in this population. Extended use varenicline may represent an effective treatment for cancer patients who smoke given barriers to cessation including a prolonged time-line for relapse. Methods: A placebo-controlled randomized trial tested 12 weeks of varenicline plus 12 weeks of placebo (standard; ST) vs. 24 weeks of varenicline (extended; ET) with 7 counseling sessions for treatment-seeking cancer patients who smoke (N=207). Primary outcomes were 7-day, biochemically-confirmed abstinence at weeks 24 and 52. Treatment adherence and side effects, adverse and serious adverse events, and blood pressure were assessed. Results: Point prevalence and continuous abstinence quit rates at weeks 24 and 52 were not significantly different across treatment arms (p’s>0.05). Adherence (43% of sample) significantly interacted with treatment arm for week 24 point prevalence (OR=2.31, [95% CI:1.15–4.63, p=0.02) and continuous (OR=5.82, [95% CI:2.66–12.71], p<.001) abstinence. For both outcomes, adherent participants who received ET reported higher abstinence (60.5%, 44.2%) vs. ST (44.7%, 27.7%), but differences in quit rates between arms were not significant for non-adherent participants (ET: 9.7%, 4.8%; ST: 12.7%, 10.9%). There were no significant differences between treatment arms on side effects, adverse and serious adverse events, and rates of high blood pressure (p’s>0.05). Conclusions: Compared to ST, ET varenicline does not increase patient risk and increases smoking cessation rates among patients who adhere to treatment. Studies are needed to identify effective methods to increase medication adherence to treat patient tobacco use effectively.
Introduction A substantial proportion of cancer patients continue to smoke after their diagnosis but few studies have evaluated correlates of nicotine dependence and smoking rate in this population, which could help guide smoking cessation interventions. Aim This study evaluated correlates of smoking rate and nicotine dependence among 207 cancer patients. Methods A cross-sectional analysis using multiple linear regression evaluated disease, demographic, affective, and tobacco-seeking correlates of smoking rate and nicotine dependence. Smoking rate was assessed using a timeline follow-back method. The Fagerström Test for Nicotine Dependence measured levels of nicotine dependence. Results A multiple linear regression predicting nicotine dependence showed an association with smoking to alleviate a sense of addiction from the Reasons for Smoking scale and tobacco-seeking behavior from the concurrent choice task (p < .05), but not with affect measured by the HADS and PANAS (p > .05). Multiple linear regression predicting prequit showed an association with smoking to alleviate addiction (p < .05). ANOVA showed that Caucasian participants reported greater rates of smoking compared to other races. Conclusions The results suggest that behavioral smoking cessation interventions that focus on helping patients to manage tobacco-seeking behavior, rather than mood management interventions, could help cancer patients quit smoking.
Targeted smoking cessation treatment, rather than extending treatment duration, may be especially warranted to optimize treatment for smokers with comorbid mood, anxiety, and substance use disorders.
Purpose: American cancer centers supported by the National Cancer Institute (NCI) must ensure that their research addresses the cancer relevant needs and risks of members of their catchment area. In 2016, the NCI supported catchment area assessments. This is the first study to describe a cancer center catchment area cancer risk evaluation, focusing on tobacco use and lung cancer screening. Methods: A cross-sectional survey was conducted in 2017 with 1,005 residents within a Philadelphia cancer center catchment area to identify the rate and correlates of smoking and rate of lung cancer screening. Results: The rate of current smoking in the catchment was 13%. Current smokers were more likely to have depression/ anxiety, less likely to be eating healthy, more likely to use e-cigarettes, and endorsed lower perceived health and higher cancer fatalism, vs. former (27%) or never smokers; 74% of smokers want to quit smoking, but two-thirds think nicotine dependence medications are unsafe and ineffective, which may be addressed with personalized treatment. E-cigarette use was 11% and lung screening rates were < 30%. Conclusions: These results indicate that addressing tobacco use in the cancer center's catchment may require targeting comorbid psychiatric conditions and additional cancer risk behaviors such as poor diet, modifying cancer beliefs that may undermine cessation, and utilizing novel methods to promote utilization of evidence-based treatment for smoking. E-cigarette use should be targeted, as well as identifying methods to promote lung screening. This study shows how a cancer center can identify catchment area needs to plan research that reduces the burden of cancer among their residents.
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