Predictors of Varenicline Adherence Among Cancer Patients Treated for Tobacco Dependence and its Association With Smoking Cessation

Crawford, Grace; Weisbrot, Jessica; Bastian, Joseph; Flitter, Alex; Jao, Nancy C.; Carroll, Allison J.; Kalhan, Ravi; Leone, Frank T.; Hitsman, Brian; Schnoll, Robert A.

doi:10.1093/ntr/nty133

Cited by 16 publications

(21 citation statements)

References 18 publications

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“…These results converge with a growing literature that highlights the importance of adherence in determining varenicline efficacy and continues to underscore the need for interventions designed to address medication adherence within tobacco use treatment programs. We have shown previously that greater varenicline adherence among cancer patients may be associated with reductions in depressed mood and perceived satisfaction from smoking and an increase in the toxic effects of smoking, while cognition, craving, and side effects may also be important . These results can guide the development and evaluation of interventions targeting varenicline adherence to improve cessation in this population.…”

Section: Discussionmentioning

confidence: 85%

“…We have shown previously that greater varenicline adherence among cancer patients may be associated with reductions in depressed mood and perceived satisfaction from smoking and an increase in the toxic effects of smoking, while cognition, craving, and side effects may also be important. 27…”

Section: Discussionmentioning

confidence: 99%

“…Participants were excluded for daily use of nicotine products other than cigarettes, and unstable substance abuse/dependence in the last year. Additional inclusion and exclusion information can be found elsewhere …”

Section: Participantsmentioning

confidence: 99%

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A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence

et al. 2019

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“… 6 , 28 Importantly, good adherence to smoking cessation treatment among patients with COPD in China significantly improved the smoking cessation efficacy, which was consistent with studies in the other population. 15 , 29 …”

Section: Discussionmentioning

confidence: 99%

“…There are a few studies about adherence to smoking cessation treatment among patients with chronic diseases. 11 , 15 However, to the best of our knowledge, it is unclear what factors will influence adherence to smoking cessation among smokers with COPD.…”

Section: Introductionmentioning

confidence: 99%

Adherence and Efficacy of Smoking Cessation Treatment Among Patients with COPD in China

Qin¹,

Liu²,

Zhou³

et al. 2021

COPD

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Background Smoking cessation is a key intervention for all smokers with chronic obstructive pulmonary disease (COPD). Poor treatment adherence is a challenge in clinical practice that might contribute to the lower efficacy of medication (eg, oral drug). However, it is unclear what factors will influence adherence among smokers with COPD. Methods This study was based on an open-label randomized controlled trial (RCT) of varenicline and bupropion for smoking cessation among patients with COPD in China. The medication was given for 12 weeks, and visits and assessments were conducted at weeks 0, 1, 2, 4, 6, 9, 12, and 24. We assessed whether the adherence to smoking cessation treatment affects the smoking cessation efficacy and evaluated predictors of adherence. Results A total of 136 participants were recruited from February 2019 to June 2020, and analyzed using the intention-to-treat (ITT) method. In this study, 48.5% (66/136) of the total participants had good adherence to smoking cessation, and good adherence significantly improved the efficacy of smoking cessation (OR=9.60, 95% CI 4.02–22.96, P < 0.001). After adjusting for age, gender, nationality, education, and marital status, we found older age, higher education level, having more previous quitting attempts, stronger self-efficacy and preparation in quitting smoking, recognizing hazards of smoking, longer duration of COPD, and higher St. George’s Respiratory Questionnaire (SGRQ) scores were relevant to good adherence (P < 0.05). Conclusion To our best knowledge, this is the first study to evaluate adherence to smoking cessation treatment among patients with COPD in China. Our study found that good adherence to smoking cessation treatment significantly improved the smoking cessation efficacy, and predictors of adherence were evaluated. We call on the medical community to pay attention to the adherence to smoking cessation among patients with COPD.

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Nicotine receptor partial agonists for smoking cessation

Livingstone‐Banks

Fanshawe

Thomas

et al. 2023

Cochrane Database of Systematic Reviews

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Background Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). This is an update of a Cochrane Review first published in 2007. Objectives To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. Selection criteria We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e‐cigarettes, or no medication. We excluded trials that did not report a minimum follow‐up period of six months from baseline. Data collection and analysis We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow‐up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel‐Haenszel fixed‐effect model. We also reported the number of people reporting serious adverse events (SAEs). Main results We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate‐certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I 2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I 2 = 0%; 3 studies, 3781 participants; low‐certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I 2 = 60%, 41 studies, 17,395 participants), and moderate‐certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I 2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I 2 = 0%; 18 studies, 7151 participants; low‐certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I 2 = 0%; 22 studies, 7846 participants; low‐certainty evidence), in both cases evidence was limited ...

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Predictors of Varenicline Adherence Among Cancer Patients Treated for Tobacco Dependence and its Association With Smoking Cessation

Abstract: The benefits of varenicline for treating tobacco dependence among cancer patients may depend upon boosting adherence by addressing early signs of depression and reducing the reinforcing dimensions of cigarettes.

Cited by 16 publications

References 18 publications

A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence

A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence

Adherence and Efficacy of Smoking Cessation Treatment Among Patients with COPD in China

Nicotine receptor partial agonists for smoking cessation

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