Integrating Tobacco Treatment into Cancer Care

描述(申请人提供)：作为对《健康传播和实施研究》标准杆10-38的回应，我们建议研究将两种循证烟草治疗方法整合到现实世界的癌症护理环境中。癌症确诊后戒烟可能会通过减少手术、放疗或化疗的并发症以及降低第二原发肿瘤的风险来提高患者的生活质量并改善治疗结果。确诊时，大约10%-30%的癌症患者是吸烟者，许多人具有更高的社会经济、生物和心理社会脆弱性。美国卫生与公众服务部公共卫生服务部有基于证据的烟草治疗指南，但这些指南尚未纳入癌症护理。美国临床肿瘤学会的一项核心质量指标是对所有吸烟者的第二次癌症就诊进行识别、建议和咨询，但这些质量标准没有得到满足。为了解决这一治疗差距，我们建议进行第一次比较有效性试验，以评估两种循证烟草治疗在新诊断的癌症患者中的有效性。我们的建议是以Park博士从一项非随机对照试验(5R03CA130722-02)中发现的结果为指导的，该试验显示了在马萨诸塞州综合医院(MGH)为新诊断的肺癌患者提供循证强化治疗(IT)的前景光明的可行性和有效性。我们建议在MGH和纪念斯隆-凯特琳癌症中心(MSK)招募295名新诊断为肺癌、结肠癌、乳腺癌或前列腺癌(四种最常见的癌症)的当前吸烟者，并比较提供强化治疗(IT；10次激励咨询会议加上FDA批准的12周戒烟药物)和简短治疗(BT；MSK目前提供的治疗，即4次激励咨询会议加药物建议)的不同有效性。目的1比较两种烟草治疗方法在6个月后促进生化确认的烟草戒断的效果。目标2将评估治疗促进禁欲的机制、促进禁欲的亚群以及促进禁欲的治疗方面。目标3将探索有多少吸烟者参加并坚持烟草治疗。这个建议的独到之处在于它的理论[(结合慢性病(自我调节)) 和行为改变(健康信念模式)]，2)综合烟草治疗(针对正在接受癌症治疗的患者)，以及3)协作式护理模式(可持续，并通过最先进的电子健康记录系统促进)。研究结果将回答以前未回答的问题，即作为全面癌症护理的一部分，提供综合烟草治疗。此外，它将提供信息，为在各种癌症护理环境中传播努力奠定基础。公共健康相关性：该项目的目标是能够显著提高生活质量和癌症的烟草使用行为 越来越多的癌症幸存者的治疗结果。

DESCRIPTION (provided by applicant): In response to the Dissemination and Implementation Research in Health PAR 10-38, we propose to examine the integration of two evidence-based tobacco treatments into real-world cancer care settings. Quitting smoking after cancer diagnosis may increase patients' quality of life and improve treatment outcomes through decreases in complications from surgery, radiation or chemotherapy, and decreases in risk of second primary tumors. At diagnosis, approximately 10-30% of cancer patients are smokers, and many have elevated socioeconomic, biologic, and psychosocial vulnerabilities. The U.S. Department of Health and Human Services Public Health Service has evidence-based tobacco treatment guidelines, but these have not been integrated into cancer care. An American Society of Clinical Oncology core quality indicator is identification, advice, and counseling of all smokers by their second cancer visit, but these quality standards are not being met. To address this treatment gap, we propose to conduct the first comparative effectiveness trial to assess the effectiveness of two evidence-based tobacco treatments among newly diagnosed cancer patients. Our proposal is guided by Dr. Park's findings from a nonrandomized controlled pilot study (5R03CA130722-02) which showed promising feasibility and efficacy for delivering an evidence-based Intensive Treatment (IT) to newly diagnosed lung cancer patients at Massachusetts General Hospital (MGH). We propose to enroll 295 current smokers newly diagnosed with lung, colon, breast, or prostate cancer (the four most prevalent cancers) at MGH and Memorial Sloan Kettering Cancer Center (MSK) and compare the differential effectiveness of delivering an Intensive Treatment (IT; 10 motivational counseling sessions plus 12 weeks of FDA approved smoking cessation medication) versus a Brief Treatment (BT; the current treatment provided at MSK, which is 4 motivational counseling sessions plus medication advice). Aim 1 will compare the effectiveness of the two tobacco treatments in promoting biochemically confirmed tobacco abstinence at 6 months. Aim 2 will assess mechanisms through which treatment promotes abstinence, subpopulations in which abstinence is promoted, and aspects of treatment that promote abstinence. Aim 3 will explore how many smokers enroll in, and adhere to, tobacco treatment. This proposal is unique in its 1) theory [(combining a chronic illness (Self-Regulation) and behavior change (Health Belief) model)], 2) integrated tobacco treatments (targeted to patients undergoing cancer treatment), and 3) collaborative care model (sustainable and facilitated through state-of- the art electronic health record systems). Study findings will addres previously unanswered questions about provision of integrated tobacco treatment as part of comprehensive cancer care. Furthermore, it will provide information to lay the groundwork for dissemination efforts into a variety of cancer care settings. Public Health Relevance: This project targets tobacco use behaviors that can significantly improve the quality of life and cancer treatment outcomes among a growing population of cancer survivors.