Approximately 40% of all cancer diagnoses are smoking-related. In those diagnosed with cancer, it is especially important to encourage and support smoking cessation, as smoking cessation can improve outcomes, increasing survival rates and enhancing response to treatment. Nonetheless, about 10% to 30% of individuals diagnosed with cancer continue to smoke.
In a recent study, Dr. Elyse Park, Director of Behavioral Sciences at the MGH Tobacco Research & Treatment Center, and colleagues look at the effectiveness of two different interventions for smoking cessation in a group of men and women recently diagnosed with cancer. Participants with a new diagnosis of cancer (breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma) were randomized into two groups.
Participants randomized to the first group received standard treatment (n = 150) which consisted of four weekly telephone counseling sessions and education and advice on medications used for smoking cessation. Participants randomized to the intensive treatment group (n = 153) received the standard number of counseling session plus an additional 4 biweekly and 3 monthly telephone counseling sessions. In addition, they were offered 12 weeks of free treatment with an FDA–approved smoking cessation medication (nicotine replacement therapy, bupropion, or varenicline).
Biochemical testing (measuring cotinine levels) was used to determine 7-day tobacco abstinence. At 3 months of follow-up, quit rates were 31.1% in the intensive treatment group compared to 20.7% in the standard treatment group (odds ratio, 1.72 [95% CI, 1.00-2.96]; P = .048). At six months, quit rates were 34.5% in the intensive treatment group) compared to 21.5% in the standard treatment group (odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). In the intensive treatment group, 77.0% reported use of a cessation medication compared to 59.1% in the standard treatment group (difference, 17.9%; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003); while participants in the intensive treatment group were more likely to use a medication for smoking cessation, medication use was not associated with quitting.
In this trial, researchers demonstrated that providing sustained telephone counseling coupled with the provision of free smoking cessation medication resulted in significantly greater abstinence rates at 6 months compared to a shorter, yet similar, intervention. Theory-based cancer-targeted counseling led to improvements in smoking and cancer beliefs, emotions and physical experiences, and smoke-free home environment modifications, factors which were associated with quitting.
Previous studies have demonstrated that extending the duration of smoking cessation interventions can reduce the risk of relapse. In this trial, a greater number of sessions, as well as engagement in monthly booster sessions, was associated with increased likelihood of quitting. Among patients who were abstinent at 6 months, one-third had quit between 3 and 6 months.
Because continued smoking after a cancer diagnosis is associated with worse outcomes, specifically decreased treatment effectiveness, increased risk of recurrence, and overall decreased survival, It is essential that healthcare providers take this opportunity to educate patients recently diagnosed with cancer about the risks of continued smoking and are able to offer effective interventions which increase the likelihood of quitting and sustained abstinence.
Park ER, Perez GK, Regan S, Muzikansky A, et al. 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: A Randomized Clinical Trial. JAMA. 2020 Oct 13;324(14):1406-1418.
Elyse Park, PhD, MPH is the Director of Behavioral Sciences at the MGH Tobacco Research & Treatment Center and an Associate Professor of Psychiatry at Harvard Medical School. Dr. Park is a clinical health psychologist and health services researcher who focuses on understanding and improving health-related behaviors, especially smoking cessation among vulnerable medical populations.
