Lung cancer is the leading cause of cancer mortality in the U.S. and a well-known health consequence of cigarette smoking. The diagnosis of late stage lung cancer has a profound effect on patients and their families and may be particularly impactful for relatives who smoke. Proposed is a two-arm randomized intervention trial that targets late stage lung cancer patients' relatives who smoke. Patients newly diagnosed with lung cancer at stages IIIb or IV who are initiating care at three large thoracic oncology units (Duke, University of North Carolina at Chapel Hill, and Durham VA) will be identified weekly from automated databases. These patients (approximately 950 over a two-year period) will be surveyed by telephone to enumerate their relatives who smoke and request permission to contact these relatives. Eligible relatives will be contacted to request their participation in the intervention trial. Those who agree to participate and complete the baseline survey will be stratified, based on the number of eligible relatives enumerated, and randomly assigned to either a Standard Self-help arm (n=240) or a Coping-focused Self-help arm (n=240). Relatives in the Standard Self-help arm will be sent an introductory letter signed by the patient's oncologist, a smoking cessation kit (e.g., nicotine patches, relaxation tapes) and a tailored booklet. Relatives in the Coping-focused arm will receive a 12-week intervention that includes the same components described above plus 6 calls from a counselor. The objective of the Coping-focused intervention is to help smokers reduce emotional distress by teaching them approach-oriented coping (e.g., relaxation techniques, reframing self-defeating appraisals, use of self-help cessation aids) and discourage avoidant-oriented coping (e.g., distancing and denial of personal benefits of smoking cessation) to enhance their ability to take steps toward quitting. The primary outcome of the trial is biochemically confirmed 7-day point prevalent abstinence at the three follow-ups, 2 weeks, 6- and 12- months post-treatment. In addition, changes in mediating factors including coping strategies and self- efficacy related to emotion management and smoking cessation and their association with intervention outcomes will be analyzed. Lastly, cost-effectiveness of the two intervention approaches also will be evaluated.
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