Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer

Abstract

IMPORTANCE Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care.OBJECTIVE To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking. DESIGN, SETTING, AND PARTICIPANTSThis unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018.INTERVENTIONS Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline). MAIN OUTCOME AND MEASURESThe primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates. RESULTS Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2). CONCLUSIONS AND RELEVANCE Among smokers recently diagnosed with cancer in 2 NationalCancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research.

Smoking Cessation by Combined Medication and Counselling in Lung Cancer Patients Effectiveness in A High Prevalence Real Life Setting

“…Achieved smoking abstinence rate was 37,5% after 12 and 32,8% after 24 weeks and thus comparable to results in other patient groups or healthy subjects (12,13,21). A recent unblinded study randomly assigned 303 patients with newly diagnosed cancer to an intensive treatment group, with 11 smoking cessation telephone counselling sessions coupled with 12 weeks of free cessation medication or to standard therapy (22). The 7-day abstinence rates at 6-month was 35% in the intensive treatment versus 22% in the standard group.…”

Telehealth Delivery of Tobacco Cessation Treatment in Cancer Care: An Ongoing Innovation Accelerated by the COVID-19 Pandemic

“…7 However, quitlines typically provide brief interventions and focus on tobacco users who are ready to quit. 8 Because patients with cancer experience unique stressors that can inhibit cessation, 9 the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for treating tobacco use among patients with cancer recommend a more robust treatment than currently provided by quitlines or many community programs. 10 Prepandemic, the Cancer Center Cessation Initiative (C3I) had enabled many NCI-designated Cancer Centers to provide in-person and/or remotely delivered cessation services.…”

It Takes Two to Tango: Patients’ and Providers’ Perspectives in Tobacco Cessation and Head/Neck Cancer

“…Pharmacotherapy and cognitive‐behavioral intervention are the standard evidence‐based treatment (EBT) for tobacco dependence [12]. In fact, recent findings indicate that, for individuals with tobacco‐related cancers, tobacco cessation services should not only be provided long term [13] but should be provided in the oncology setting [14]. However, there is sparse literature on interventions designed for patients with HNC [15–17].…”