Continued smoking among cancer patients is associated with poor survival, a greater risk of disease recurrence and a second primary tumor, reduced treatment efficacy, and greater recovery- related complications. Nevertheless, about 50 percent of patients who smoked prior to diagnosis continue to do so following diagnosis/treatment. Despite evidence that hospital- based smoking cessation interventions improve tobacco abstinence rates, cancer patients have largely been neglected as a target population for smoking cessation treatment and research. This empirical gap is surprising since smoking cessation can improve prognosis and enhance quality of life for cancer patients, and can be uniquely effective when delivered in a medical context. The few studies which have assessed the efficacy of smoking cessation treatments for cancer patients have yielded limited data due to the use of small samples and the failure to address possible psychological determinants of smoking. Thus, guided by the research team's Cognitive-Social Health Information- Processing (C-SHIP) model, and influenced by preliminary studies of predictors of continued smoking among cancer patients, this study proposes to assess the impact of an individualized, cognitive-behavioral smoking cessation intervention for patients with head, neck, or lung cancer. This intervention targets cognitive and emotional variables considered predictive of smoking by cancer patients (i.e., perceived risk, self-efficacy, fatalistic beliefs, pros and cons of quitting, emotional distress). Using a randomized prospective design, the aims to be addressed are:
Aim 1 : To compare an individualized cognitive- behavioral smoking cessation intervention to an AHCPR-consistent, time and attention matched, general health educational treatment for increasing readiness to change (i.e., trans-theoretical model stage measure of intention to quit) and reducing smoking rates (i.e., 30-day point prevalence, number of 24-hour quit attempts, number of cigarettes smoked) in a sample of head, neck, and lung cancer patients;
Aim 2 : To examine psychological mediators of the effects of the cognitive-behavioral treatment, including risk perceptions, self-efficacy, fatalistic beliefs, pros and cons of quitting, and emotional distress. This study will allow for the assessment of the added benefit of a cognitive-behavioral intervention to the AHCPR minimum standard of care. Further, this study will assess the generalizability of the C-SHIP model to the tobacco control area. Lastly, this study will permit the identification of the psychological variables that underlie smoking abstinence among cancer patients. The data garnered from this study should have wide applicability in allowing for informed decisions concerning the implementation of cognitive- behavioral smoking cessation approaches for cancer patients on a broader scale.
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