Intensive Counseling Improves Smoking Cessation Rates in Patients With Cancer

Robust telephone counseling programs can improve smoking abstinence rates in patients with cancer, according to the results of a study published in JAMA.¹

A number of oncology groups have emphasized the need to incorporate tobacco cessation therapy among cancer patients. The National Cancer Institute identified cancer treatment as an opportune time to provide tobacco treatment to patients.² However, a meta-analysis of intervention trials conducted between 1993 and 2018 indicates that the optimal smoking cessation treatment for patients with cancer has yet to be identified.³

The study authors, led by Elyse R. Park, PhD, PHM, of Massachusetts Hospital and Harvard Medical School, hypothesized that among patients recently diagnosed with cancer, intensive cessation counseling and the provision of free smoking cessation medication could improve rates of tobacco abstinence at 6-month follow-up.

A total of 303 participants were recruited from Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center in Boston and Memorial Sloan Kettering Cancer Center in New York City to participate in the study. Adult patients who were undergoing treatment for breast, gastrointestinal, genitourinary, gynecologic, head and neck, lymphoma, melanoma, or lung cancer and self-reported smoking at least 1 cigarette in the past 30 days were eligible for the study. Patients who could not speak English or Spanish, did not have telephone access, or had a cognitive impairment deemed likely to inhibit their participation in the study were excluded.

Patients were randomly assigned to a standard treatment group or intensive treatment group. The median participant age was 59 years; 56.1% of participants were women; 84.2% were non-Hispanic White; and 31.5% had a high school degree or less.

Standard vs Intensive Intervention

Patients in the standard treatment group were offered 4 weekly telephone counseling sessions in addition to education and advice regarding US Food and Drug Administration (FDA)-approved cessation medications. Counselors used a decision aid specifically designed for patients with cancer to make medication recommendations during the first counseling session.

In the intensive treatment group, patients received the standard treatment plus 4 biweekly telephone sessions delivered over 2 months and 3 telephone booster sessions delivered monthly. Patients randomly assigned to this group were offered a 12-week supply of a smoking cessation medication of their choice (varenicline, bupropion sustained release, single or combination nicotine replacement therapy patch and/or lozenges), though medication use was not required. After receiving an initial 4-week supply, patients had the option to receive up to 2 additional 4-week supplies of medication at no cost.

In both the standard and intensive treatment groups, telephone counseling was delivered by certified tobacco treatment counselors using a motivational interviewing style with a focus on cognitive behavioral therapy, stress management, and resiliency strategies.

Biochemical confirmation of smoking abstinence was completed in 2 different ways depending on patient needs: patients who self-reported tobacco abstinence (defined as cotinine level <15 ng/mL) at either 3 or 6 months were mailed a saliva collection kit, while patients who self-reported smoking abstinence (defined as <10 particles per million expired carbon monoxide) but still used nicotine replacement therapy or nicotine-containing e-cigarettes provided an in-person expired air carbon monoxide sample.

Intensive Treatment Linked to Greater Smoking Abstinence

The study’s primary outcome was biochemically confirmed 7-day point prevalence cigarette smoking abstinence at 6-month follow-up. Approximately one-third (34.5%) of patients in the intensive treatment group vs 21.5% of patients in the standard treatment group achieved 7-day abstinence at 6-month follow-up (odds ratio [OR], 1.92; 95% CI, 1.13-3.27; P <.02).

At 3-month follow-up, 31.1% of patients in the intensive treatment group were biochemically confirmed abstinent compared with 20.7% in the standard treatment group (OR, 1.72; 95% CI, 1.00-2.96; P =.048). However, 29.7% of patients who were confirmed abstinent at 3 months relapsed between 3 and 6 months. At 6 months, the rate of sustained abstinence was 23.6% in the intensive treatment group and 12.6% in the standard treatment group (OR, 2.15; 95% CI, 1.14-4.05; P <.02).

Patients in the intensive treatment group completed more sessions on average than their counterparts in the standard treatment group (8 sessions vs 4 sessions). Approximately two-thirds (63.5%) of participants in the intensive group took advantage of at least 1 booster counseling session available to them, and 54.7% completed at least 2 booster sessions.

Participants in the intensive group were more likely to use cessation medication; at 6 months, 77% of patients in the intensive group self-reported medication use compared with 59.1% of participants in the standard group. Out of the 122 patients (79.7%) in the intensive group who received any medication, 57.4% received more than a 4-week supply. Nicotine replacement therapy was the most popular cessation medication selected by participants; accounting for 79.5% of patients who received medication.

Greater Number of Counseling Sessions Linked to Better Outcomes

Among the intensive treatment group, researchers linked a greater number of counseling sessions completed and a greater number of booster sessions completed to an increased likelihood of quitting smoking. Researchers did not find a significant difference in likelihood of quitting based on cessation medication use, sociodemographic characteristics, cancer type, or medical or smoking history.

Patient satisfaction was notably higher in the intensive group; 85% of participants stated that the program met all or most of their needs compared with 59.3% in the standard treatment group.

“The trial’s theory-based cancer-targeted counseling showed that improvements in smoking and cancer beliefs, emotions and physical experiences, and smoke-free home environment modifications were associated with quitting,” the study authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

Park ER, Perez GK, Regan S, 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;324(14):1406-1418. doi:10.1001/jama.2020.14581
Croyle RT, Morgan GD, Fiore MC. Addressing a core gap in cancer care: the NCI Moonshot program to help oncology patients stop smoking. N Engl J Med. 2019;380(6):512-515. doi:10.1056/NEJMp1813913
Sheeran P, Jones K, Avishai A, et al. What works in smoking cessation interventions for cancer survivors? A meta-analysis. Health Psychol. 2019;38 (10):855-865. doi:10.1037/hea0000757

This article originally appeared on Clinical Advisor