Patients With Serious Mental Illness Can Engage in Tobacco Treatment Trials and Tobacco Cessation Interventions During Cancer Treatment

摘要

QUESTION ASKED: Can individuals with serious mental illness (SMI) and cancer participate in tobacco cessation trials that are integrated into cancer care? SUMMARY ANSWER: Patients with SMI were able to engage in and benefit from a pragmatic tobacco cessation trial that was integrated into cancer care. WHAT WE DID: More than half of adults with SMI smoke, and smoking is a leading contributor to premature cancer mortality in this population. A cancer diagnosis provides an opportunity to address smoking cessation as part of cancer care delivery. However, many adults with SMI lack access to tobacco cessation treatment. Clinicians may hesitate to prescribe tobacco cessation medications, given concerns about safety and efficacy. Additionally, clinical trials frequently exclude patients with SMI. To address this gap, we analyzed the relationship between SMI and smoking cessation among participants with recent cancer diagnoses at two National Cancer Institute-designated Cancer Centers who were enrolled in a pragmatic trial of a tobacco cessation intervention. The trial limited exclusion because of mental illness to active psychosis or a suicide attempt within the past year. We compared self-reported smoking behaviors and beliefs about tobacco cessation, engagement in the trial and tobacco cessation intervention, and smoking abstinence among patients with cancer with and without SMI. WHAT WE FOUND: We recruited 303 patients of which 10% had SMI (major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders). Participants with SMI were equally motivated to quit smoking compared with patients without mental illness. 48.4% (15/31) of patients with SMI reported that their oncologists recommended cessation counseling compared with 60.6% of patients without SMI, and 32.3% (10/31) reported being recommended cessation medications versus 47.3% (121/256) of patients without SMI. Participants with SMI were able to consent, enroll, and complete study assessments at similar rates compared with participants without mental illness. Additionally, participants with SMI completed a similar number of tobacco cessation counseling sessions (6.5 v 7.3 sessions), had similar rates of self-reported medication use, and similar quit rates at 3 and 6 months (32.3% [10/31] with SMI versus 28% [70/252] without SMI).