美国纪念斯隆-凯特琳癌症中心Jamie S. Ostroff联合马萨诸塞州总医院Elyse R. Park团队研究了持续戒烟咨询和药物治疗与短期咨询和药物建议对近期确诊癌症患者戒烟的影响。2020年10月13日，该研究发表在《美国医学会杂志》上。

持续吸烟可能会导致癌症患者的不良预后。许多癌症中心尚未将戒烟治疗完全纳入常规护理中。为了确定持续电话咨询和药物治疗（强化治疗），与短期电话咨询和药物治疗建议（标准治疗）来帮助近期确诊癌症患者戒烟的有效性，研究组进行了一项非盲的随机临床试验。

2013年11月至2017年7月，研究组招募30天内吸烟1支及以上，说英语或西班牙语，并且最近被诊断出乳腺癌、胃肠癌、泌尿生殖道癌、妇科癌、头颈癌、肺癌、淋巴瘤或黑色素瘤的成年患者。将其随机分组，其中153例接受强化治疗，150例接受美国食品药物管理局批准的标准治疗。主要结局为6个月随访时生化证实的7天点戒烟率。

303名患者的平均年龄为58.3岁，其中170名为女性（56.1%），共有221名（78.1%）完成了试验。强化治疗组6个月时经生化确认的戒烟率为34.5%，显著高于标准治疗组（21.5%）。强化治疗组平均完成了8次咨询。强化治疗组中有97名患者（77.0%）报告停止了药物治疗，显著高于标准治疗组（59.1%）。强化治疗组中最常见的不良事件包括13例恶心、4例皮疹、4例打嗝、4例口腔刺激、3例失眠和3例多梦，标准治疗组则包括6例恶心、1例皮疹、1例打嗝、2例失眠和2例多梦。

总之，对于吸烟的癌症患者，采用持续咨询和提供免费戒烟药物的策略，与4周咨询和用药建议相比，在6个月时的戒烟率更高。

附：英文原文

Title: Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer: A Randomized Clinical Trial

Author: Elyse R. Park, Giselle K. Perez, Susan Regan, Alona Muzikansky, Douglas E. Levy, Jennifer S. Temel, Nancy A. Rigotti, William F. Pirl, Kelly E. Irwin, Ann H. Partridge, Mary E. Cooley, Emily R. Friedman, Julia Rabin, Colin Ponzani, Kelly A. Hyland, Susan Holland, Sarah Borderud, Kim Sprunck, Diana Kwon, Lisa Peterson, Jacob Miller-Sobel, Irina Gonzalez, C. Will Whitlock, Laura Malloy, Suhana de León-Sanchez, Maureen O’Brien, Jamie S. Ostroff

Issue&Volume: 2020/10/13

Abstract:

Importance  Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care.

Objective  To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking.

Design, Setting, and Participants  This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018.

Interventions  Participants randomized to the intensive treatment (n=153) and the standard treatment (n=150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration–approved cessation medication (nicotine replacement therapy, bupropion, or varenicline).

Main Outcome and Measures  The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates.

Results  Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n=51 in the intensive treatment group) vs 21.5% (n=29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P<.02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P=.003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n=13 and n=6), rash (n=4 and n=1), hiccups (n=4 and n=1), mouth irritation (n=4 and n=0), difficulty sleeping (n=3 and n=2), and vivid dreams (n=3 and n=2).

Conclusions and Relevance  Among smokers recently diagnosed with cancer in 2 National Cancer Institute–designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research.

DOI: 10.1001/jama.2020.14581

Source: https://jamanetwork.com/journals/jama/article-abstract/2771608