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

癌症诊断后继续吸烟与生存时间缩短、复发风险增加、第二原发恶性肿瘤、治疗并发症增加和治疗失败有关。尽管继续吸烟对健康有不利影响，但50%在诊断前吸烟的癌症患者在诊断后继续吸烟。不幸的是，烟草使用治疗在大多数国家癌症研究所（NCI）癌症中心并不被认为是一项核心服务，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，很少有针对癌症患者的戒烟试验，许多已经进行的试验缺乏对戒烟的生化验证。很少有针对西班牙裔吸烟者的戒烟临床试验，我们也不知道有任何针对目前正在接受癌症治疗的西班牙裔吸烟者的临床试验。最近举行的NCI癌症中心治疗烟草依赖会议（NCl-CTTDCC）强调了改进这些治疗的必要性，并呼吁进行研究，评估将戒烟治疗纳入护理提供和维持戒烟的方法。有证据表明，癌症患者对尼古丁的依赖程度更高，并且比一般吸烟者有更多的共病情绪和情绪症状，这表明他们可能需要比标准护理方法更密集的治疗形式。戒烟热线已被发现显着增加禁欲率相比，简短的干预。虽然quitines在为一般人群中的吸烟者提供戒烟支持方面的有效性已经得到了很好的证实，但目前正在接受癌症治疗的癌症患者使用quitlines的意愿尚不清楚。根据NCI-CTTDCC的建议，评估将戒烟治疗纳入癌症护理的策略，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部分的可行性;并估计短期干预咨询和戒烟热线（BC+）相结合的效果大小与短期咨询（BC）相比，3个月和6个月随访时的禁欲情况。为了实现这些目标，正在接受癌症治疗且目前吸烟的癌症患者将被随机分配接受简短的咨询加在肿瘤诊所（BC）提供的戒烟药物治疗，或BC干预加由波多黎各戒烟热线（BC+）提供的7次咨询。将在戒烟后3个月和6个月评估吸烟结果。这项试验的数据将用于支持更大规模的临床试验，评估西班牙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.