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
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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DOI：
10.1001/jama.2020.14581
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发表时间：
2020-10-13
影响因子：
120.7
通讯作者：
Ostroff, Jamie S.
中科院分区：
文献类型：
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作者：
Park, Elyse R.;Perez, Giselle K.;Ostroff, Jamie S.
要点问题对于最近诊断出癌症的吸烟者，持续戒烟电话咨询加药物治疗与短期电话咨询加药物治疗相比效果如何？结果在这项在 2 个美国国家癌症研究所指定的综合癌症中心进行的 303 名患者的随机临床试验中，与 4 周的电话咨询和药物建议相比，持续超过 6 个月的电话咨询和提供免费药物的结果是，6 个月生化证实的戒烟率分别为 34.5% 和 21.5%，差异具有统计学意义。意义在最近被诊断出患有癌症的患者中，与短期咨询相比，持续戒烟咨询和免费药物治疗可能会增加戒烟的可能性，但该研究结果的普遍性尚不确定，需要进一步研究。重要性持续吸烟可能会导致癌症患者出现不良后果。许多癌症中心尚未将循证烟草治疗完全纳入常规护理中。目的确定持续电话咨询和药物治疗（强化治疗）与短期电话咨询和药物建议（标准治疗）相比，在帮助新近诊断出癌症的患者戒烟方面的有效性。设计、设置和参与者这项非盲随机临床试验在马萨诸塞州总医院/达纳法伯/哈佛大学癌症中心和纪念斯隆凯特琳癌症中心进行。 30 天内吸 1 支或以上香烟、说英语或西班牙语、最近诊断出乳腺癌、胃肠癌、泌尿生殖癌、妇科癌、头颈癌、肺癌、淋巴瘤或黑色素瘤的成年人符合资格。注册发生在2013年11月至2017年7月期间；评估于 2018 年 2 月底完成。干预措施参与者随机接受强化治疗 (n=153) 和标准治疗 (n=150)，每周接受 4 次电话咨询和药物建议。强化治疗组还接受 4 次每两周一次和 3 个月一次的电话咨询，并选择食品和药物管理局批准的戒烟药物（尼古丁替代疗法、安非他酮或伐尼克兰）。主要结果和措施 主要结果是在 6 个月的随访中经生化证实的 7 天点吸烟率。次要结果是治疗利用率。结果 在 303 名随机分配的患者中（平均年龄 58.3 岁；170 名女性 [56.1%]），221 名患者 (78.1%) 完成了试验。六个月生化证实的戒烟率为 34.5%（强化治疗组 n=51）vs 21.5%（标准治疗组 n=29）（差异为 13.0% [95% CI, 3.0%-23.3%]；比值比，1.92 [95% CI, 1.13-3.27]；P
Key PointsQuestionHow effective is sustained cessation telephone counseling plus medication treatment compared with shorter-term telephone counseling plus medication advice for smokers recently diagnosed with cancer? FindingsIn this randomized clinical trial of 303 patients, conducted at 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained telephone counseling over 6 months and provision of free medication compared with 4-week telephone counseling and medication advice resulted in 6-month biochemically confirmed quit rates of 34.5% vs 21.5%, a difference that was statistically significant. MeaningAmong patients recently diagnosed with cancer, sustained cessation counseling and free medication may increase the likelihood of smoking abstinence compared with shorter-term counseling, but the generalizability of the study findings is uncertain and requires further research.ImportancePersistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. ObjectiveTo 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. InterventionsParticipants 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. ResultsAmong 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