Contingency Management to Promote Smoking Abstinence in Cancer Patients

项目总结 癌症患者中吸烟的发生率很高。许多人以前无法戒烟 手术，在那些在最初的癌症诊断后能够戒烟的人中，复发率很高。 吸烟与治疗的严重并发症有关，包括增加伤口问题。 手术后痊愈。应急管理，一种加强禁欲的行为干预 (通常是通过金钱奖励)，已经显示出作为吸烟干预措施的前景。在我们的预赛中 在这项工作中，我们为术前癌症患者设计了应急管理方案。一项初步研究是 进行以产生手术时戒烟的效果大小(7天点流行率 禁欲)，次要目标是为术后3个月的长期禁欲创造一个效果大小。 患者(N=40)随机接受标准护理+监测(SC；即3-6次咨询 疗程+尼古丁替代疗法[NRT]+每周监测呼气CO 3次，无NO 应急；N=19)或CM(即3-6次咨询会议+NRT+货币付款，视情况而定 负呼气CO；N=21)。在CM组中，52%(11/21)的患者在戒断前7天内戒断 手术治疗的比例为16%(3/19)(调整后RR=3.3，CI：1.1~9.7，P=0.03)。在3个月内 随访，43%(9/21)的CM患者保持戒断状态，而SC组(调整后)为5%(1/19 RR=8.6，CI：1.5~49.4，P=0.02)。在目前的研究中，我们建议进行有动力的大规模吸烟(N=282) 停止临床试验，以测试对癌症患者的CM干预。这次干预将反映我们之前的工作， 重点关注正在接受癌症手术的患者。还没有研究对CM干预进行评估 患有危及生命的疾病的吸烟者。然而，我们的试点数据显示，手术前癌症患者 Smoke已经表明，这可能是一种很有希望的癌症患者干预措施。我们假设这是 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研究不足， 在促进改善手术结果方面的宝贵工具。

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.