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Cited by 114Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesLung Cancer Diagnosis and Treatment

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

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Park, Elyse R., Perez, Giselle K., Regan, Susan, Muzikansky, Alona, Levy, Douglas E., Temel, Jennifer S., Rigotti, Nancy A., Pirl, William F. +19 more·2020·JAMA
DOI 10.1001/jama.2020.14581PMC PMC8094414
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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 Participants: This 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 Measures: The 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 National Cancer 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. Trial Registration: ClinicalTrials.gov Identifier: NCT01871506.

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Authors
Park, E. R., Perez, G. K., Regan, S., Muzikansky, A., Levy, D. E., Temel, J. S., Rigotti, N. A., Pirl, W. F., Irwin, K. E., Partridge, A. H., Cooley, M. E., Friedman, E. R., Rabin, J., Ponzani, C., Hyland, K. A., Holland, S., Borderud, S., Sprunck, K., Kwon, D., Peterson, L., Miller-Sobel, J., Gonzalez, I., Whitlock, C. W., Malloy, L., de León-Sanchez, S., O’Brien, M., & Ostroff, J. S.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
  • Moffitt Cancer Center (US)
  • Memorial Sloan Kettering Cancer Center (US)
  • Dana-Farber Cancer Institute (US)
  • Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
Corresponding author
Park, Elyse R.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2020-10-13
Volume
324
Issue
14
Pages
1406
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2020.14581
PMC
PMC8094414
OpenAlex
W3092359548
Cited by
114
References
40
Citations by year
2026: 17 · 2025: 18 · 2024: 17 · 2023: 18 · 2022: 31 · 2021: 11 · 2020: 2
FWCI
9.29
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Pfizer
  • National Institutes of Health (UL1TR002384)
  • National Cancer Institute (K24CA197382, R01CA166147, K08CA230185, P30CA008748)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
smoking cessation, cancer patients, telephone counseling, nicotine replacement therapy, bupropion, varenicline, smoking abstinence, treatment utilization, Spanish-speaking patients, breast cancer, lung cancer, head and neck cancer, gastrointestinal cancer, lymphoma, melanoma, genitourinary cancer, gynecologic cancer
MeSH terms
Varenicline, Smoking Cessation Agents, Aged, Cotinine, Counseling, Decision Support Techniques, Female, Humans, Male, Middle Aged, Neoplasms, Saliva, Smoking, Telephone, Temperance, Smoking Cessation, Bupropion, Patient Satisfaction, Patient Selection, Tobacco Use Cessation Devices, Motivational Interviewing

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