The Dynamics of Smoking Cessation After Cancer Diagnosis: A Naturalisitic Study

描述（由申请人提供）：本NCI K07申请中提出的活动旨在促进Jessica Burris博士的职业发展，她的长期职业目标是维持一个独立、创新和有意义的临床研究项目，重点关注癌症患者的烟草使用和戒烟。大多数临床医生认为癌症诊断是一个教育的时刻，因此敦促在癌症诊断后立即戒烟。然而，大多数戒烟尝试以复发告终，现有的癌症患者戒烟干预措施收效甚微。癌症诊断会带来许多个人内部和人际之间的变化（例如，情绪困扰的增加，对社会支持的更大需求，个人风险的显著性增加），但对这些变化如何影响戒烟的了解很少。着眼于干预发展，本申请中提出的独立研究将检查癌症诊断后戒烟的自然过程以及吸烟行为变化背后的动态。具体目标是：1)描述戒烟过程中的关键事件；2)揭示促进或破坏新诊断癌症患者戒烟尝试、失败和复发发生的认知和情感变量。基线评估后（N=120头颈癌患者），参与者将通过交互式语音应答技术开始为期30天的每日评估，并在基线评估后三个月进行最终评估。在30天每日IVR评估结束时，通过唾液可替宁样本进行戒断的生化验证和最终评估。统计分析将允许进行新的测试，以了解认知和情感变量的日常变化如何以及在多大程度上影响新诊断癌症患者的戒烟结果。创新是通过以下方式实现的：1)关注戒烟过程，而不是将戒烟治疗作为一个离散的结果；2)对戒烟结果的认知和情感预测因素给予同等关注；3)使用移动技术作为癌症患者数据收集的主要手段；4)适当应用纵向数据分析技术来丰富受试者内部数据。补充独立研究的培训计划包括课程、研讨会、讲习班、指导研究、期刊俱乐部和会议，这些组合将涵盖以下主题：尼古丁依赖；烟草控制的个人层面和公共卫生方法；纵向研究的设计、协调与执行；先进的统计技术；研究传播;grantsmanship;以及研究的道德行为。优秀导师团队的大力支持，以及南卡罗来纳医科大学广阔的资源和优秀的科研环境，创造了最优的培养环境。总的来说，NCI K07申请中提出的综合研究和培训计划是促进Burris博士职业发展的理想机制。

DESCRIPTION (provided by applicant): The activities proposed in this NCI K07 application are designed to advance the career development of Dr. Jessica Burris, whose long-term career goal is to sustain an independent, innovative, and meaningful clinical research program that focuses on tobacco use and cessation in cancer patients. Most clinicians view cancer diagnosis as a teachable moment, and thus urge immediate smoking cessation after delivery of cancer diagnosis. However, most quit attempts end in relapse and extant interventions for smoking cessation in cancer patients have limited success. A cancer diagnosis brings about many intra- and inter-personal changes (e.g., increase in emotional distress, greater need for social support, increase in saliency of personal risk), but there is very little understanding as to how such changes influence smoking cessation. With an eye toward intervention development, the independent research proposed in this application will examine the naturalistic course of smoking cessation after cancer diagnosis as well as the dynamics that underlie changes in smoking behavior. Specific aims are 1) to describe key events in the process of smoking cessation and 2) to uncover cognitive and affective variables that promote or undermine the occurrence of a quit attempt, lapse, and relapse among newly diagnosed cancer patients. After a baseline assessment (N=120 head and neck cancer patients), participants will initiate a 30-day period of daily assessment via interactive voice response technology, with a final assessment to occur three months after the baseline assessment. Biochemical verification of abstinence at the end of the 30-day daily IVR assessment and final assessment will be achieved through use of saliva cotinine samples. Statistical analysis will allow novel tests of how, and to what extent, day-to-day changes in cognitive and affective variables influence smoking cessation outcomes in newly diagnosed cancer patients. Innovation is achieved by: 1) a focus on the process of smoking cessation as opposed to the treatment of abstinence as a discrete outcome, 2) equal attention given to cognitive and affective predictors of smoking cessation outcomes, 3) use of mobile technology as the primary means of data collection among cancer patients, and 4) proper application of longitudinal data analysis techniques to rich within-subjects data. A training plan that complements the independent research includes coursework, seminars, workshops, mentored research, journal clubs, and conferences, the combination of which will cover these topics: nicotine dependence; individual-level and public health approaches to tobacco control; longitudinal research design, coordination, and execution; advanced statistical techniques; research dissemination; grantsmanship; and ethical conduct of research. The strong support of an excellent team of mentors, and the vast resources and outstanding scientific environment of the Medical University of South Carolina, create an optimal training environment. Collectively, the integrated research and training plan proposed in this NCI K07 application are an ideal mechanism to promote the career development of Dr. Burris.