Tobacco control measures in cancer patients and their families need improvement. Radiotherapy (RT) patients present for daily treatment over many weeks, often accompanied by friends and family. This time in the RT clinic represents a powerful opportunity for tobacco cessation using an intensive behavioral intervention along with drug therapy concurrently with RT.
Materials/Methods
Eligible participants included smoking cancer patients scheduled to receive ≥3 weeks of RT and their family/friends who use tobacco and accompany the cancer patient to RT. All participants received bupropion and 9 individualized behavioral interventions (BI) in the RT clinic with an addiction professional, followed by 9–12 scheduled intensive relapse prevention (RP) encounters (in person or by telephone). The primary endpoint was feasibility determined by accrual and program completion. Other endpoints included carbon-monoxide (CO) confirmed and participant-reported tobacco abstinence. During 4 months of enrollment, smoking and basic eligibility data were prospectively collected on consultations seen in clinic.
Results
Over 8 months, 3 family members and 20 cancer patients were enrolled. Based on our sampling, this represented greater than 40% of eligible smokers seen in clinic. A wide variety of malignancies were represented with every major tumor site enrolled except skin and CNS. 10/20 cancer patients enrolled were diagnosed with tobacco-related malignancy. 10 cancer patients received chemotherapy. Six cancer patients withdrew, all on or before the third BI. No family member withdrew. Reasons patients withdrew were typically cessation of daily RT or difficulty with BI scheduling. 13 participants completed all 9 BIs while 4 patients completed 7–8 BIs. 11 participants reported compliance with bupropion therapy. One participant discontinued bupropion citing increased depression. No other possible adverse events to bupropion or BI were discovered. At the completion of BI, 13/16 participants had exhaled CO concentrations <10 ppm and 12/17 participants self-reported tobacco abstinence. The median tobacco follow-up for the 17 patients completing the intervention was 10.4 months (range 2.5–15.5 months). Of the 15 patients alive and with follow-up at least 6 months, 8 reported tobacco abstinence for a crude 6-month self-reported tobacco abstinence of 50%. Both of the two patients who died before 6 months reported tobacco abstinence at last RP/FU encounter (2.5 and 3.9 months respectively). All three of the family members enrolled reported tobacco abstinence at 6 months.
Conclusions
Tobacco cessation with bupropion and intensive BI for cancer patients and their companions during RT was feasible. A significant number of eligible smokers, including family members, enrolled and completed BI during RT. However, there was significant difficulty in achieving in clinic relapse prevention encounters following RT.
Indiana University, Indianapolis, IN
Author Disclosure: D.J. Hoopes, None; D. Hudson, None; M. Langer, None; B. Sinha, None; H. Pai, None; A. McDaniel, None.
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