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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Lung cancer is the leading cause of cancer death in both men and women. Cigarette smoking is responsible for 87% of lung cancers, and half of patients are current smokers at the time of cancer diagnosis. Patients with earlier stages of lung cancer who are candidates for lung resection have a relatively good prognosis. Lung cancer diagnosis is a powerful motivator to quit smoking, and half or more of smokers quit after the diagnosis is made. However, many smokers do not quit, and those who quit at the time of diagnosis often relapse soon after surgery. Continuing to smoke is associated with poorer treatment outcomes and greater risk for second smoking-related primary tumors including lung cancer. We hypothesize that cessation rates after lung cancer diagnosis can be improved by providing a state-of-the-art smoking cessation intervention in a sustained fashion that begins before surgery and continues in the hospital and after discharge. Further, we propose to tailor the intervention to the specific psychosocial issues of newly diagnosed smokers with lung cancer and implement an intervention in a way that fits easily into the pattern of clinical care for lung cancer patients. To date, this has not been done. We will develop a brief smoking cessation intervention that combines cognitive-behavioral and pharmacological treatment and is targeted to newly diagnosed early stage (I-II) lung cancer patients who are awaiting surgery. The intervention will be implemented at Massachusetts General Hospital in Boston. The aims of this pilot study are to enroll 30 subjects, assess the intervention's acceptability and feasibility, and gather data on cessation rates attained at the pre-operative evaluation visit (just prior to surgery) and 3 months after surgery. Cessation rates in the intervention group will be compared to a historical control group of 20-30 participants who will be enrolled prior to implementation of the intervention. If the intervention is feasible and appears to be potentially efficacious, the next step will be to develop a full-scale randomized controlled trial to test the efficacy of the intervention. PROJECT RELEVANCE Despite the fact that continued smoking after a lung cancer diagnosis adversely affects the survival of these patients, an effective smoking cessation intervention for smokers with newly diagnosed early stage lung cancer has not been identified. We propose to assess the efficacy and potential feasibility of a combined behavioral and pharmacological treatment program that is integrated into the thoracic oncology setting.