2018 ASCO Annual Meeting!
Session: Health Services Research, Clinical Informatics, and Quality of Care
Type: Oral Abstract Session
Time: Friday June 1, 2:45 PM to 5:45 PM
Integrating tobacco treatment into cancer care: A first snapshot of RCT findings.
Care Delivery/Models of Care
Health Services Research, Clinical Informatics, and Quality of Care
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr 6505)
Author(s): Elyse R. Park, Giselle Katiria Perez, Susan Regan, Alona Muzikanksy, Nancy Rigotti, Douglas E. Levy, Jennifer S. Temel, Mary E. Cooley, Ann H. Partridge, William F. Pirl, Kelly Irwin, Emily R. Friedman, Sarah Borderud, Kelly Hyland, Julia Rabin, Kim Sprunck, Diana Kwon, Jamie S. Ostroff; Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA, US; Dana-Farber Cancer Institute, Boston, MA; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL; Memorial Sloan Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
Background: Despite ASCO recommendations that tobacco use be assessed and managed, most cancer patients who smoke do not receive tobacco treatment. Evidence-based tobacco treatment has not yet been integrated into routine oncology care, and the optimal tobacco treatment strategy in this context is unknown. Methods: We conducted a two-arm, two-site RCT to compare sustained counseling plus medication (Intervention Group; IG) to standard tobacco counseling (comparison group; CG) to assist newly diagnosed cancer patients to quit smoking. Both treatment groups received 4 weekly telephone-delivered motivational counseling sessions. The IG additionally received 4 biweekly plus 3 monthly counseling sessions (total 11) and 12-weeks of free FDA-approved cessation medication (nicotine replacement therapy (NRT; patch/lozenge), varenicline, or bupropion). Eligibility criteria included a recent cancer diagnosis (breast, GI/GU, gyn, head & neck, lymphoma, lung, melanoma), cigarette use in the past 30 days, and English/Spanish speaking. The primary outcome was 6-month biochemically verified abstinence. Results: 303 (70% of confirmed eligibles) patients were enrolled and randomized to a treatment group. Participants were 56% female; 82% white non-Hispanic and 10% black; mean age = 58.3 (sd = 9.7); 40% had a non-smoking related tumor. 86% completed the 6-month surveys. 80% of IG patients used a smoking cessation medication, among which 83% selected NRT. Using intention-to-treat, 6-month quit rates were 33% in the IG group vs. 19% in the CG group (p < .02). Using intention-to-treat, 57% of IG patients were adherent to sustained counseling (≥7 sessions), which was associated with increased 6-month quit rates (p < .0001). Cost per patient was $1,273 (IG) vs. $838 (CG). Conclusions: Among newly-diagnosed cancer patients, a treatment program of sustained telephone-delivered counseling and free medication produced a higher 6-month quit rate vs. a briefer counseling program. The cost-per-quit compared favorably to other cessation interventions. Findings provide strong support for the benefit of sustained tobacco treatment and a model for effective implementation of tobacco treatment into oncology care settings nationwide. Clinical trial information: NCT01871506