Examining Delivery of Integrated Tobacco Treatment in Cancer Care

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 DESCRIPTION (provided by applicant): Documented risks associated with continued smoking following cancer diagnosis include decreased survival time; increased complications from surgery, radiation, and chemotherapy; and increased risk of second primary tumors. Although 10%-30% of cancer patients are current smokers at the time of cancer diagnosis, an effective smoking cessation treatment for cancer patients has not been established. Evidence-based tobacco treatment guidelines, and ASCO quality recommendations, have not been integrated into cancer care. With NCI support I have created a research focus and commitment to advocate for integrating evidence-based quality tobacco treatment as part of comprehensive cancer care. I am currently conducting a two site randomized clinical trial (1R01CA166147) to compare the efficacy and cost of an intensive treatment (counseling delivered over 6 months (weekly x 1 month, biweekly x two months, and monthly x 3 months) plus choice of 12-weeks of FDA approved medication) to a standard of care treatment (counseling delivered over one month plus medication advice) to 295 cancer patients at the time of diagnoses. An R21 has been proposed to conduct a pilot trial to assess integration of the intensive treatment into community-based cancer centers, delivered via a web-based telehealth program. This K24 proposal fills a needed gap in patient-oriented tobacco treatment for cancer patients. Junior clinician-scientists are needed in this area of patient-oriented care; the population of cancer patients is growing, and an interdisciplinary cadre of clinical researchers are needed who have a unique interest in both tobacco treatment and cancer care and are dedicated to improving tobacco treatments targeted for cancer patients as well as pursuing innovative treatment delivery options. The proposed K24 work would enable me, together with a highly qualified group of mentees, to 1) determine and create the best quality evidence-based treatment, 2) further expand its relevance and appeal to diverse cancer patients, 3) determine the most effective assessment of this treatment, and 4) expand its reach. Mentorship Aim: To expand my ability to mentor multidisciplinary junior clinician-scientists in patient oriented research relatig to tobacco treatment for cancer patients. The proposed work includes 10 mentee-lead projects. Research Aim: To build upon my R01, integrating tobacco treatment into academic medical settings, to 1) further develop and refine patient-oriented tobacco treatment for diverse cancer patients who are smoking at diagnosis and 2) position myself to expand and improve the reach and effectiveness of tobacco treatment delivery into community-based oncology settings. The proposed work will involve multiple phases of patient- oriented research, which will culminate in translation of information gained back into the cancer patient population. The phases include: 1) qualitative data collection (exit interviews) with a subset of R01 patients (n=60), 2) data analyses and mixed methods interpretation of R01 patient data on a) cancer distress and symptoms , b) health behaviors, and target populations and patient communication.