Smoking Cessation Therapy May be Effective in Cervical Cancer Survivors

Novel smoking cessation treatment Motivation and Problem Solving (MAPS) outperformed standard smoking cessation therapy at 12 months but was comparable with standard treatment at 18 months among survivors of cervical intraepithelial neoplasia and cervical cancer, according to findings from a study published in the Journal of Clinical Oncology.

"To our knowledge, this study represents the first smoking cessation intervention trial specifically designed to address the treatment needs of [survivors] with a history of [cervical intraepithelial neoplasia] or cervical cancer,” according to the authors of a study published in the Journal of Clinical Oncology.

At 18 months, MAPS yielded an abstinence rate of 14.2% vs 12.8% with standard treatment (P = .79; odds ratio [OR], 1.14; 95% CI, 0.44-2.93). Nonetheless, MAPS yielded a higher abstinence rate at 12 months (26.4%) than standard treatment (11.9%; P = .017; OR, 2.60; 95% CI, 1.19-5.89).

Generalized estimating equations for abstinence rates across the 4 assessments did not identify significant main effect (P = .60). There was, however, a significant condition X assessment interaction (P = .015).

“To our knowledge, this study represents the first smoking cessation intervention trial specifically designed to address the treatment needs of [survivors] with a history of [cervical intraepithelial neoplasia] or cervical cancer,” the investigators wrote. “Our study is also one of few smoking cessation trials among cancer survivors to evaluate the efficacy of an intervention lasting 12 months and one of only two trials to collect follow-up data through 18 months.”

This randomized controlled trial assessed data from a total of 202 survivors enrolled between February 2017 and January 2020 and 194 were eligible for data analysis. Of this population, 82% were retained, providing data at 18 months.

Standard anti-smoking treatment in the study consisted of a mailed packet containing a letter referring survivors to their state’s tobacco cessation quitline along with self-help materials. The packets were delivered at baseline and at 6 and 12 months. Additionally, survivors received 12 weeks of combination nicotine replacement therapy comprising patches and lozenges.

MAPS included all standard treatment components plus up to 6 proactive telephone counseling sessions given within 12 months from baseline. The timing of these sessions conformed to the needs of each individual survivor, often clustering around quit attempts.

The primary end point of the study was self-reported 7-day point abstinence from tobacco after 18 months. Secondary end points included abstinence from tobacco at 3, 6, and 12 months as well as biochemically confirmed abstinence.

The mean age in both treatment arms was approximately 48 years. Survivors in both arms were most commonly White and began smoking at a mean age of approximately 17 years. Survivors smoked a mean of roughly 15 cigarettes per day. Most in both groups had completed their treatment and attained a high school diploma but no further education.

Roughly 41.3% of patients had an annual household income of less than $20,000, with a further 39.1% having an income of $20,000 to $50,000. Most patients had either cervical intraepithelial neoplasia (42%), or stage I (33%) or stage II (12%) cervical cancer.

Those receiving MAPS therapy completed an average of 3.9 sessions (SD = 2.0), with 60% completing at least 4 sessions. These sessions had a median length of 32.6 minutes (SD = 13.8) and the mean number of minutes patients spent in counseling was 125.9 minutes (SD = 72.7). The abstinence rate among those who completed 4 to 6 sessions was 38.3% compared with 8.5% among those who completed 0 to 3 sessions (P = .009; OR, 1.95; 95% CI, 1.32-2.40).

Usage of nicotine replacement therapy and treatment satisfaction levels were comparable across both groups.

“MAPS was dynamically tailored to the specific treatment needs of [survivors] with a history of [cervical intraepithelial neoplasia] or cervical cancer and was associated with more than a two-fold increase in abstinence at 12 months compared with a quitline control condition,” the investigators concluded.

“This effect was no longer significant at 18 months, suggesting that the efficacy of MAPS dissipated as the time from the end of treatment increased. This decline does not appear to have been driven by dropout as retention was high, which signals motivation for long-term treatment engagement and highlights the need for sustained intervention.”

Reference

Vidrine JI, Sutton SK, Wetter DW, et al. Efficacy of a smoking cessation intervention for survivors of cervical intraepithelial neoplasia or cervical cancer: a randomized controlled trial. J Clin Oncol. Published online March 15, 2023. doi:10.1200/JCO.22.01228