Tobacco Research and Intervention Program and Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.
Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL.
J Clin Oncol. 2023 May 20;41(15):2779-2788. doi: 10.1200/JCO.22.01228. Epub 2023 Mar 15.
Women who smoke and have a history of cervical intraepithelial neoplasia (CIN) or cervical cancer represent a vulnerable subgroup at elevated risk for recurrence, poorer cancer treatment outcomes, and decreased quality of life. The purpose of this study was to evaluate the long-term efficacy of Motivation And Problem Solving (MAPS), a novel treatment well-suited to meeting the smoking cessation needs of this population.
Women who were with a history of CIN or cervical cancer, age 18 years and older, spoke English or Spanish, and reported current smoking (≥100 lifetime cigarettes plus any smoking in the past 30 days) were eligible. Participants (N = 202) were recruited in clinic in Oklahoma City and online nationally and randomly assigned to (1) standard treatment (ST) or (2) MAPS. ST consisted of repeated referrals to a tobacco cessation quitline, self-help materials, and combination nicotine replacement therapy (patch plus lozenge). MAPS comprised all ST components plus up to six proactive telephone counseling sessions over 12 months. Logistic regression and generalized estimating equations evaluated the intervention. The primary outcome was self-reported 7-day point prevalence abstinence from tobacco at 18 months, with abstinence at 3, 6, and 12 months and biochemically confirmed abstinence as secondary outcomes.
There was no significant effect for MAPS over ST at 18 months (14.2% 12.9%, = .79). However, there was a significant condition × assessment interaction ( = .015). Follow-up analyses found that MAPS ( ST) abstinence rates were significantly greater at 12 months (26.4% 11.9%, = .017; estimated OR, 2.60; 95% CI, 1.19 to 5.89).
MAPS led to a greater than two-fold increase in smoking abstinence among survivors of CIN and cervical cancer at 12 months. At 18 months, abstinence in MAPS declined to match the control condition and the treatment effect was no longer significant.
患有宫颈上皮内瘤变（CIN）或宫颈癌病史且吸烟的女性是一个处于高复发风险、癌症治疗结局较差和生活质量下降的脆弱亚组。本研究的目的是评估一种新的治疗方法——动机和问题解决（MAPS）的长期疗效，这种方法非常适合满足该人群的戒烟需求。
患有 CIN 或宫颈癌病史、年龄在 18 岁及以上、会讲英语或西班牙语且报告目前吸烟（≥100 支终生香烟加过去 30 天内任何吸烟）的女性有资格参加。参与者（N=202）在俄克拉荷马城的诊所和全国范围内在线招募，并随机分为（1）标准治疗（ST）或（2）MAPS。ST 包括多次转介到戒烟热线、自助材料和尼古丁替代疗法（贴片加含片）联合使用。MAPS 包括所有 ST 成分，以及在 12 个月内最多进行六次主动电话咨询。逻辑回归和广义估计方程评估干预措施。主要结局是在 18 个月时自我报告的 7 天点烟率，次要结局包括在 3、6 和 12 个月时的戒烟情况和生物化学证实的戒烟情况。
MAPS 组在 18 个月时与 ST 组相比没有显著效果（14.2%比 12.9%， =.79）。然而，存在条件与评估的交互作用（ =.015）。随访分析发现，MAPS 组（ST 组）在 12 个月时的戒烟率显著更高（26.4%比 11.9%， =.017；估计 OR，2.60；95% CI，1.19 至 5.89）。
MAPS 使 CIN 和宫颈癌幸存者在 12 个月时的吸烟戒断率提高了两倍以上。在 18 个月时，MAPS 组的戒烟率下降到与对照组匹配，且治疗效果不再显著。
