Examining Delivery of Integrated Tobacco Treatment in Cancer Care

 描述(由申请人提供)：在癌症确诊后继续吸烟的有记录的风险包括生存时间缩短；手术、放疗和化疗的并发症增加；以及第二原发肿瘤风险增加。虽然10%-30%的癌症患者在被诊断为癌症时是当前吸烟者，但针对癌症患者的有效戒烟疗法尚未建立。循证烟草治疗指南和ASCO质量建议尚未纳入癌症治疗。在NCI的支持下，我创建了一个研究重点，并致力于倡导将循证优质烟草治疗作为全面癌症护理的一部分。我目前正在进行一项双站点随机临床试验(1R01CA166147)，以比较295名确诊时接受强化治疗(咨询持续6个月(每周x 1个月，双周x 2个月，每月x 3个月)，外加12周FDA批准的药物治疗)和标准护理治疗(咨询超过1个月加药物建议)的疗效和成本。R21已被提议进行一项试点试验，以评估通过基于网络的远程医疗计划将强化治疗整合到以社区为基础的癌症中心。这项K24建议填补了癌症患者以患者为中心的烟草治疗方面的一个必要空白。在这一以患者为中心的护理领域需要初级临床医生-科学家；癌症患者的人口正在增长，需要一支对烟草治疗和癌症护理都有独特兴趣并致力于改进针对癌症患者的烟草治疗并寻求创新治疗方案的跨学科临床研究人员队伍。拟议的K24工作将使我能够与一群高素质的受训者一起，1)确定和创造最高质量的循证治疗，2)进一步扩大其相关性和对不同癌症患者的吸引力，3)确定对这种治疗的最有效评估，以及4)扩大其覆盖范围。指导目标：扩大我指导多学科初级临床医生--癌症患者烟草治疗相关研究的初级临床科学家的能力。拟议的工作包括10个由学员牵头的项目。研究目的：在My R01的基础上，将烟草治疗整合到学术医疗环境中，1)进一步开发和改进针对确诊时吸烟的不同癌症患者的以患者为导向的烟草治疗，2)定位自己，扩大和提高社区肿瘤环境中烟草治疗服务的覆盖范围和有效性。拟议的工作将涉及以患者为中心的多个阶段的研究，最终将把获得的信息转化回癌症患者群体。这些阶段包括：1)对R01患者(n=60)子集的定性数据收集(离职访谈)；2)R01患者数据的数据分析和混合方法解释：a)癌症痛苦和症状，b)健康行为，以及目标人群和患者沟通。

 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.