A Smoking Cessation Intervention for Oncology Clinics in Puerto Rico - A Pilot

摘要癌症确诊后继续吸烟与生存时间缩短、复发风险增加、第二原发癌、治疗并发症增加和治疗失败相关。尽管继续吸烟会对健康造成不利影响，但50%的癌症患者在确诊前吸烟，在确诊后仍会继续吸烟。不幸的是，在大多数国家癌症研究所(NCI)的癌症中心，烟草使用治疗并不被视为核心服务，这使得大多数想要戒烟的癌症患者得不到正式的帮助。此外，针对癌症患者的戒烟试验很少，许多已经进行的试验缺乏对戒烟的生物化学验证。很少有针对拉美裔吸烟者的戒烟临床试验，我们也不知道有任何针对正在接受癌症治疗的拉美裔吸烟者的临床试验。最近在癌症中心治疗烟草依赖的NCI会议(NCL-CTTDCC)强调了这些治疗方法改进的必要性，并呼吁进行研究，评估将戒烟治疗整合到护理提供和持续戒烟的方法。有证据表明，癌症患者比普通吸烟者更依赖尼古丁，并有更多的情感和情绪症状，这表明他们可能需要比标准护理方法更多的强化治疗形式。研究发现，与短暂的干预相比，戒烟电话显著提高了禁酒率。虽然Qutiines在为普通人群中的吸烟者提供戒烟支持方面的有效性已经得到证实，但目前正在接受癌症治疗的癌症患者使用Qutiines的意愿尚不清楚。根据NCL-CTTDCC关于评估将戒烟治疗整合到癌症护理中的策略的建议，目前的试点研究将评估在医务人员提供的基于临床实践指南的简短咨询中增加戒烟咨询成分的可行性；并估计在3个月和6个月的随访中，与单纯简短咨询(BC)相比，联合使用简短干预咨询和戒断咨询(BC+)的效果大小。为了实现这些目标，正在接受癌症治疗的目前吸烟的癌症患者将被随机分配到肿瘤诊所(BC)接受简短咨询加戒烟药物治疗，或接受BC干预加波多黎各Quitline(BC+)提供的7次咨询。吸烟结果将在戒烟后3个月和6个月进行评估。这项试验的数据将用于支持更大规模的临床试验，评估奎宁对拉美裔癌症患者的戒烟治疗。

ABSTRACT Continued tobacco smoking following a diagnosis of cancer is associated with decreased survival time, increased risk of recurrence, second primary malignancies, increased treatment complications and treatment failure. Despite the adverse health effects of continued smoking, 50% of patients with cancer who smoked prior to diagnosis continue to do so after diagnosis. Unfortunately, tobacco use treatment is not considered a core service at most ofthe National Cancer Institute (NCI) cancer centers, leaving the majority of cancer patients who want to quit with no formal assistance. In addition, there have been few smoking cessation trials for cancer patients and many ofthe trials that have been conducted have lacked biochemical verification of abstinence. There are very few smoking cessation clinical trials that have targeted Hispanic smokers, and we are unaware of any that have targeted Hispanic smokers currently undergoing cancer treatment. A recent NCI Conference on Treating Tobacco Dependence at Cancer Centers (NCl-CTTDCC) highlighted the need for improvement in these treatments, and has called for studies that evaluate methods for integrating cessation treatment into care delivery and sustaining cessation. There is evidence that cancer patients are more nicotine dependent and have more comorbid emotional and mood symptoms than the general population of smokers, suggesting that they may need more intensive forms of treatment than what is available through standard of care approaches. Quitlines have been found to significantly increase abstinence rates compared to brief interventions. While the effectiveness of quitiines in providing cessation support to smokers in the general population is well established, the willingness of cancer patients who are currently undergoing cancer treatment to use quitlines is unknown. In line with the recommendations of the NCl-CTTDCC to evaluate strategies for integrating cessation treatment into cancer care, the current pilot study will assess the feasibility of adding a quitline counseling component to clinical practice guideline-based brief counseling provided by medical staff; and estimate the effect size of the combined brief intervention counseling and quitline (BC+) compared to the brief counseling alone (BC) on abstinence at 3 and 6 month follow-ups. To accomplish these aims, cancer patients undergoing cancer treatment who are current smokers will be randomly assigned to receive brief counseling plus smoking cessation pharmacotherapy delivered in the oncology clinic setting (BC) or the BC intervention plus 7 counseling sessions delivered by the Puerto Rico Quitline (BC+). Smoking outcomes will be assessed at 3 and 6 months post-cessation. Data from this trial will be used to support larger scale clinical trials evaluating quitline delivered smoking cessation treatments for Hispanic cancer patients.