Contingency Management to Promote Smoking Abstinence in Cancer Patients

促进癌症患者戒烟的应急管理

• 批准号: 10641849
• 负责人: Benjamin Andrew Toll
• 金额: $ 48.56万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-07 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641849
• 关键词: Abstinence; Adjuvant; Advocate; American Association of Cancer Research; American Society of Clinical Oncology; Behavior Therapy; Biochemical; Breath Tests; Cancer Intervention; Cancer Patient; Carbon Monoxide; Clinical; Clinical Trials; Cost Analysis; Counseling; Data; Day Surgery; Diagnosis; Effectiveness of Interventions; Funding; Health; Incidence; Infrastructure; Intervention; Intervention Studies; Life; Link; Malignant Neoplasms; Monitor; National Comprehensive Cancer Network; Operative Surgical Procedures; Participant; Patients; Perioperative; Pilot Projects; Population; Prevalence; Protocols documentation; Randomized; Recommendation; Relapse; Research; Research Design; Risk; Second Primary Cancers; Site; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Smoking Status; Subgroup; Surgical complication; Testing; Time; Tobacco Use Cessation; Tobacco use; Treatment-related toxicity; United States National Institutes of Health; Work; Wound Infection; cancer care; cancer diagnosis; cancer site; cancer surgery; cancer therapy; clinical care; contingency management; cost effective; design; effective intervention; effective therapy; effectiveness evaluation; financial incentive; follow-up; high risk; improved; long term abstinence; medical complication; mortality; nicotine replacement; novel; payment; randomized, clinical trials; respiratory; smoking abstinence; smoking cessation; smoking intervention; standard care; surgery outcome; surgical risk; tobacco abstinence; tool; treatment response; wound healing

PROJECT SUMMARY There is a high incidence of tobacco use among patients with cancer. Many are unable to quit smoking before surgery, and relapse rates are high among those who are able to abstain after the initial cancer diagnosis. Tobacco use is linked to serious complications with treatment, including increased problems with wound healing after surgery. Contingency management, a behavioral intervention in which abstinence is reinforced (typically with monetary incentives), has shown promise as an intervention for smoking. In our preliminary work, we designed a contingency management protocol for pre-surgical cancer patients. A pilot study was conducted to generate an effect size for smoking cessation at the time of surgery (7-day point prevalence abstinence), and a secondary aim of creating an effect size for long-term abstinence at 3 months post-surgery. Patients (N=40) were randomized to receive either: Standard Care + Monitoring (SC; i.e., 3-6 counseling sessions + nicotine replacement therapy [NRT] + monitoring breath CO 3 times per week with no contingencies; N=19) or CM (i.e., 3-6 counseling sessions + NRT + monetary payment delivered contingent on a negative breath CO; N=21). In the CM group 52% (11/21) of the patients were abstinent for 7 days prior to surgery compared to 16% (3/19) of the patients in SC (adjusted RR=3.3, CI: 1.1-9.7, p=0.03). At the 3-month follow-up, 43% (9/21) of CM patients remained abstinent compared to 5% (1/19) in the SC group (adjusted RR=8.6, CI: 1.5-49.4, p=0.02). For the present study, we propose a powered, large scale (N=282) smoking cessation clinical trial to test a CM intervention for cancer patients. The intervention will mirror our prior work, focusing on patients who are undergoing surgery for their cancer. No studies have evaluated a CM intervention with smokers who have a life-threatening illness. However, our pilot data with pre-surgical cancer patients who smoke has shown that this may be a promising intervention with cancer patients. We hypothesize that this highly effective treatment, by promoting high rates of smoking cessation, will also be associated with better surgical outcomes. Interventions for smoking cessation prior to cancer surgery are understudied and a valuable tool in promoting improved surgical outcomes.

项目摘要 癌症患者中使用烟草的发生率很高。许多人之前无法戒烟 在最初的癌症诊断后能够弃用的手术和复发率很高。 烟草使用与治疗的严重并发症有关，包括伤口问题增加 手术后的愈合。应急管理，一种强化禁欲的行为干预 （通常具有货币激励措施），已显示出有望作为吸烟的干预措施。在我们的初步中 工作，我们为手术前癌症患者设计了一项应急管理方案。试点研究是 进行手术时戒烟的效果大小（7天的患病率） 禁欲），以及在手术后3个月创建长期禁欲的效果大小的次要目的。 患者（n = 40）被随机接受：标准护理 +监测（SC;即3-6咨询 会议 +尼古丁替代疗法[NRT] +监控呼吸Co每周3次，没有 偶然性； n = 19）或cm（即3-6次咨询会议 + NRT +货币付款 负面呼吸co； n = 21）。在CM组52％（11/21）中，患者戒酒了7天 手术为SC中的16％（3/19）（调整后的RR = 3.3，CI：1.1-9.7，p = 0.03）。在3个月 随访，CM患者的43％（9/21）仍然戒酒，而SC组为5％（1/19）（调整后 RR = 8.6，CI：1.5-49.4，p = 0.02）。对于本研究，我们提出了一个大规模的动力（n = 282）吸烟 停止临床试验，以测试癌症患者的CM干预。干预将反映我们先前的工作， 专注于正在接受癌症手术的患者。没有研究评估CM干预 与患有威胁生命的疾病的吸烟者。但是，我们的试验数据与手术前癌症患者 烟雾表明，这可能是对癌症患者的有希望的干预。我们假设这是 高效的治疗方法是通过促进戒烟率高的速度，也将与更好的治疗 手术结果。癌症手术前停止戒烟的干预措施被研究了 有价值的工具，可促进改进的手术结果。

项目成果

Preoperative contingency management intervention for smoking abstinence in cancer patients: trial protocol for a multisite randomised controlled trial.

• DOI: 10.1136/bmjopen-2021-051226
• 发表时间: 2021-06-29
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Rojewski AM;Fucito LM;Baker NL;Palmer AM;Foster MG;Warren GW;Bernstein SL;Toll BA
• 通讯作者: Toll BA