Smoking cessation offers an important way for newly diagnosed cancer patients to take an active role in their treatment and recovery. Quitting smoking decreases cancer patients' risk of disease recurrence, development of second primary cancers, and morbidity and mortality. In addition, preoperative smoking cessation may reduce risks to pulmonary and cardiovascular functioning during and after surgery. Due to patients' heightened awareness of these health hazards, and their increased motivation to be actively involved in their cancer care, rates of cessation after cancer diagnosis are high. However, 35 percent to 69 percent of patients continue to smoke and this is largely due to significant barriers to quitting (low-self efficacy, psychological distress) rather than lack of positive intentions to quit. Previous attempts to increase smoking cessation among the medically ill have provided intervention either during or after hospitalization. We propose that the period immediately prior to hospitalization and surgery represents a unique window of opportunity, or """"""""teachable moment,"""""""" for smoking cessation that could take full advantage of patients' enhanced health awareness and quitting motivation, strong physician quitting advice, and patients' heightened desire to take an efficacious role in their care. The primary goal of this study is to test the effectiveness of a presurgical smoking cessation intervention that adds scheduled reduced smoking, a highly effective behavioral treatment in non-medically ill smokers, to hospital counseling and nicotine replacement therapy. This study will also examine whether enhanced quitting self-efficacy represents the primary mechanism explaining the influence of the intervention on smoking cessation. This randomized, prospective, two-arm study will use an experimental design, with primary smoking outcomes measured at the time of hospitalization and at 3 and 6 months post hospital discharge. We predict that by improving self-efficacy for quitting, the addition of scheduled reduced smoking will significantly increase smoking cessation success over that achieved by hospital counseling and nicotine replacement. Delivering effective smoking cessation treatment early in the cancer experience and the novel application of a potent behavioral therapy represent an innovation in capitalizing on the teachable moment of cancer diagnosis. Testing the potential mediational role of quitting self-efficacy in smoking outcomes in hospital-based treatment represents a theoretical advance in smoking cessation.
