Enhancing motivation to quit smoking via self-help intervention targeted to cancer type: A pilot RCT

Project Summary/Abstract Tobacco smoking is causally related to at least 12 cancer types. Quitting smoking after cancer is critical for improved treatment outcomes; however, over two-thirds of smokers continue to smoke after a cancer diagnosis. Smoking after cancer increases the risk of mortality and is associated with poorer cancer treatment

efficacy, treatment complications, development of second primary tumors, and cancer recurrence. Continued smoking also places patients at greater risk of other non-cancer related health consequences (e.g., cardiovascular disease) and reduced quality of life. Thus, smoking cessation is extremely important for cancer

patients regardless of cancer type. However, our previous research demonstrated that patients with non- smoking related cancers (e.g., breast) or with cancers that are not widely known to be smoking-related (e.g., bladder) report lower smoking cessation motivation and poorer cessation rates compared to patients with a

cancer for which smoking is a well-established risk factor (e.g., thoracic). Thus, the aim of my systematic independent research line is to increase smoking cessation motivation, and ultimately enhance smoking abstinence rates, among patients with cancers not typically linked to smoking. With NCI R03 funding, I

developed five brief booklets targeted by cancer type to increase motivation to quit smoking among patients with cancers that are not smoking related (i.e., breast, melanoma) or not widely recognized as smoking related (i.e., bladder, colorectal, gynecological). The proposed project continues the systematic development of this

intervention by piloting testing randomized controlled trial (RCT) procedures, and by assessing contextual factors to inform its future implementation in oncology treatment settings. We will conduct two rigorous studies. In Study I, we will randomize 100 patients with one of the aforementioned cancer diagnosis (20 per cancer site)

to receive usual care (brief advice + Quiltine EHR referral) vs. usual care plus our targeted self-help intervention to examine the feasibility of RCT procedures (i.e., recruitment rates, randomization, adherence, treatment fidelity, attrition, acceptability, and credibility) and to establish confidence intervals of estimated

efficacy of our intervention in increasing smoking cessation motivation compared to usual care. Simultaneously, in Study II, using a sequential mixed-methods approach, we will collect quantitative and qualitative data from clinic leaders and other stakeholders in the oncology setting (e.g., physicians, nurses,

tobacco treatment specialists) who could be involved in providing smoking cessation assistance to identify: (1) intervention delivery modality and source; (2) potential barriers and facilitators to implementation; (3) recommended implementation strategies for seamless integration into routine care; and (4) current practice

patterns and organizational readiness for change. This study, in coordination with the proposed training plan in sophisticated study designs, implementation science, and complex data analysis will provide the necessary preliminary data and expertise needed for a successful career as an independent investigator.