ASCO 2018: Randomised Clinical Trial Shows That Sustained Counselling Yields Higher Tobacco Quit Rates

Patients with a variety of cancers benefit from tobacco treatment strategies

A sustained counselling programme improved 6-month tobacco quit rates over a standard counselling programme, researchers reported at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held 1 to 5 June in Chicago, USA. Furthermore, higher quit rates were associated with receiving a longer duration of sustained counselling. 

Currently, ASCO recommends that tobacco use be assessed and managed; however, most cancer patients who smoke do not receive tobacco cessation treatment as part of their cancer treatment regimen in the US. 

According to Elyse R. Park, Massachusetts General Hospital, in Boston, USA the optimal tobacco treatment strategy has not yet been determined and evidence-based tobacco treatment has not been integrated into routine oncology care. This prompted Dr. Park and colleagues to compare sustained counselling plus medication to standard tobacco counselling for assisting smoking cessation in patients with newly diagnosed cancers. 

The two-arm, two-site randomised controlled trial ( NCT01871506) required all patients to be English or Spanish speaking and to have a recent cancer diagnosis of breast, gastrointestinal/genitourinary, gynaecological, head and neck, lymphoma, lung, or melanoma. Patients were also required to have used cigarettes within the past 30 days. 

Of those meeting these criteria, 303 (70%) patients were randomised to a treatment group; the intervention group received 4 weekly telephone-delivered motivational standard counselling sessions and 4 biweekly plus 3 monthly sustained counselling sessions for a total of 11 additional sessions. This treatment group was also offered 12-weeks of free FDA-approved cessation medication of nicotine replacement therapy (NRT) consisting of a patch/lozenge, varenicline, or bupropion. The comparison group received only the standard 4 weekly telephone-delivered motivational counselling. 

The primary outcome of the study was 6-months of biochemically verified abstinence. 

Quit rates were highest in patients receiving more counseling sessions 

Fifty-six percent of the study participants were women, 82% were white non-Hispanic, and 10% were black with a mean (standard deviation) age of 58.3 (±9.7) years. Non-smoking related tumours had been diagnosed in 40% of the patients. 

The 6-month survey completion rate was 86%. A smoking cessation medication was used by 80% of the intervention group; of these patients, 83% selected NRT. 

Outcomes were evaluated using intention-to-treat. The 6-month tobacco quit rates were 33% in the intervention group compared to just 19% in the comparison group (p < 0.02). In the intervention cohort, 57% of patients were adherent to sustained counselling and received 7 or more sessions, which significantly associated with increased 6-month quit rates (p < 0.0001). 

The sustained tobacco treatment strategy was more expensive, with a cost per patient of 1,273 USD in the intervention group compared to 838 USD per comparison group patient. 

Conclusions 

These data demonstrate that a treatment programme of sustained telephone-delivered counselling plus free medication provided higher 6-month quit rates compared to a less intensive counselling programme without medication in patients newly-diagnosed with various cancers. 

The authors further concluded that the cost-per-quit of this programme compared favourably to other cessation interventions. 

These findings support sustained tobacco treatment and provide a model for the effective implementation of tobacco treatment into oncology care settings that could be carried out nationwide. 

Disclosure 

No external funding was disclosed. 

Reference 

Park ER, Perez GK, Regan S, et al. Integrating tobacco treatment into cancer care: A first snapshot of RCT findings. J Clin Oncol 36, 2018 (suppl; abstr 6505).