Grant Details
Grant Number: |
5R01CA251158-05 Interpret this number |
Primary Investigator: |
Toll, Benjamin |
Organization: |
Medical University Of South Carolina |
Project Title: |
Contingency Management to Promote Smoking Abstinence in Cancer Patients |
Fiscal Year: |
2024 |
Abstract
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.
Publications
Preoperative contingency management intervention for smoking abstinence in cancer patients: trial protocol for a multisite randomised controlled trial.
Authors: Rojewski A.M.
, Fucito L.M.
, Baker N.L.
, Palmer A.M.
, Foster M.G.
, Warren G.W.
, Bernstein S.L.
, Toll B.A.
.
Source: BMJ open, 2021-06-29; 11(6), p. e051226.
EPub date: 2021-06-29.
PMID: 34187835
Related Citations
A Preoperative Contingency Management Intervention for Smoking Abstinence in Cancer Patients: A Preliminary Randomized Controlled Trial.
Authors: Rojewski A.M.
, Fucito L.M.
, Baker N.L.
, Krishnan-Sarin S.
, Carpenter M.J.
, Bernstein S.L.
, Toll B.A.
.
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2021-05-24; 23(6), p. 1064-1067.
PMID: 33340400
Related Citations