Contingency Management to Promote Smoking Abstinence in Cancer Patients

项目摘要 癌症患者吸烟的发生率很高。许多人以前无法戒烟 在初次癌症诊断后能够戒酒的人中，复发率很高。 烟草使用与治疗的严重并发症有关，包括伤口问题的增加 手术后愈合。应急管理，一种加强禁欲的行为干预 （通常以金钱奖励），已显示出作为吸烟干预措施的前景。在我们的初步调查中 工作，我们设计了一个应急管理协议，为术前癌症患者。了一项初步研究 进行手术时戒烟的效应量（7天点患病率 禁欲），以及在术后3个月时创建长期禁欲的效应量的次要目的。 患者（N=40）随机接受：标准护理+监测（SC;即，3-6辅导 治疗+尼古丁替代疗法[NRT] +监测呼吸CO，每周3次，无 意外事件; N=19）或CM（即，3-6咨询会议+ NRT +视情况提供的货币支付 阴性呼吸CO; N=21）。在CM组中，52%（11/21）的患者在给药前禁欲7天 外科手术，而SC组患者为16%（3/19）（调整后RR=3.3，CI：1.1-9.7，p=0.03）。在3个月 随访时，43%（9/21）的CM患者保持禁欲，而SC组为5%（1/19）（调整后 RR=8.6，CI：1.5-49.4，p=0.02）。在本研究中，我们提出了一个动力，大规模（N=282）吸烟 停止临床试验，以测试癌症患者的CM干预。干预将反映我们之前的工作， 关注那些正在接受癌症手术的病人。没有研究评价CM干预 患有危及生命的疾病的吸烟者。然而，我们对手术前癌症患者的初步数据显示， 吸烟表明，这可能是一个有希望的干预癌症患者。我们假设这 高效的治疗，通过促进高戒烟率，也将与更好的 手术结果。癌症手术前戒烟的干预措施尚未得到充分研究， 促进改善手术结果的有价值的工具。

PROJECT SUMMARY There is a high incidence of tobacco use among patients with cancer. Many are unable to quit smoking before surgery, and relapse rates are high among those who are able to abstain after the initial cancer diagnosis. Tobacco use is linked to serious complications with treatment, including increased problems with wound healing after surgery. Contingency management, a behavioral intervention in which abstinence is reinforced (typically with monetary incentives), has shown promise as an intervention for smoking. In our preliminary work, we designed a contingency management protocol for pre-surgical cancer patients. A pilot study was conducted to generate an effect size for smoking cessation at the time of surgery (7-day point prevalence abstinence), and a secondary aim of creating an effect size for long-term abstinence at 3 months post-surgery. Patients (N=40) were randomized to receive either: Standard Care + Monitoring (SC; i.e., 3-6 counseling sessions + nicotine replacement therapy [NRT] + monitoring breath CO 3 times per week with no contingencies; N=19) or CM (i.e., 3-6 counseling sessions + NRT + monetary payment delivered contingent on a negative breath CO; N=21). In the CM group 52% (11/21) of the patients were abstinent for 7 days prior to surgery compared to 16% (3/19) of the patients in SC (adjusted RR=3.3, CI: 1.1-9.7, p=0.03). At the 3-month follow-up, 43% (9/21) of CM patients remained abstinent compared to 5% (1/19) in the SC group (adjusted RR=8.6, CI: 1.5-49.4, p=0.02). For the present study, we propose a powered, large scale (N=282) smoking cessation clinical trial to test a CM intervention for cancer patients. The intervention will mirror our prior work, focusing on patients who are undergoing surgery for their cancer. No studies have evaluated a CM intervention with smokers who have a life-threatening illness. However, our pilot data with pre-surgical cancer patients who smoke has shown that this may be a promising intervention with cancer patients. We hypothesize that this highly effective treatment, by promoting high rates of smoking cessation, will also be associated with better surgical outcomes. Interventions for smoking cessation prior to cancer surgery are understudied and a valuable tool in promoting improved surgical outcomes.