Tobacco Treatment Optimization and Preferences During Concurrent Cancer Treatment

NCT ID: NCT04634071

Last Updated: 2026-02-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

126 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-12

Study Completion Date

2026-01-02

Brief Summary

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Smoking cessation has been shown to improve the effectiveness and reduce the morbidity of tobacco-related cancer treatments. We will identify effective smoking cessation strategies for patients who are receiving treatment for tobacco-related cancer. In this trial, patients' preferences in smoking cessation therapy will be the principal determinant by providers in developing a three component regimen of pharmaceutical therapy, counseling, and nicotine replacement therapy. This study will identify this cohort's preferences for smoking cessation strategies. We will then examine the impact of utilizing patient preferences upon cessation efficacy by directly comparing cessation success in this study with our recently completed study of the same population using the same tobacco treatments which were randomly assigned.

Detailed Description

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Background Cigarette smoking is associated with decreased survival and decreased efficacy of cancer therapy in those with smoking related malignancies. There is limited of study of smoking cessation for cancer patients being treated in regions with high tobacco use such as Kentucky. There is little study of cessation implementation in the community cancer treatment setting where the majority of cancer patients receive their cancer therapy. Most smokers have significant exposure to information and personal experience with tobacco treatments which, in some cases, leads to profound preferences. The effect of incorporating these patient preferences into tobacco treatment planning has not been studied or quantified.

Study Design Phase II therapeutic clinical trial.

Setting University of Kentucky Markey Cancer Center (MCC) and its affiliate research network of Community Cancer Centers (MCCRN)

Methods Ninety-three subjects will be selected. All subjects will be active smoking oncology patients with a diagnosis of smoking related malignancy who are beginning a new course of therapy. In conjunction with their treating clinician, all subjects will be counseled and then select one of 12 cessation strategies. This will include a choice of continuous pharmacologic agent (veranicline, bupropion or transdermal nicotine patch), counseling strategy (11 session high intensity motivational based counseling or single session low intensity counseling), and whether or not to use as needed nicotine (gum, lozenges or spray).

Data Analysis All subjects will be followed for six months. The primary endpoint will be a carbon monoxide monitoring confirmed negative seven-day point prevalence report of cessation at eight weeks. Data will then be analyzed and compared with a completed randomized clinical trial of the same treatment strategies in the same population of subjects where the cessation strategy was assigned (historical control). The proportion of subjects that have quit at week eight will be compared to the historical control proportion (namely, whether Ho:p=po vs Ha: p\>po). This will be assessed using a z-score for a binomial proportion which will test whether the underlying proportion quitting at eight weeks (p) differs from the control proportion (po ranging from 0.215 to 0.26) estimated from our recently completed randomized trial of these same 12 cessation strategies.

Revised Enrollment Number: Effective with Amendment 2, Expand targeted enrollment from 96 to 126 due to higher than expected drop-out/censoring rate in order to evaluate the primary endpoint

Conditions

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Smoking Cessation Cancer, Treatment-Related

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

This trial is a parallel design. However, it is part of a broader sequential cohort design to compare the effects of preference driven tobacco treatment upon cessation versus effects of a previous cohort from a separate randomized controlled trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1: Varenicline, Intense Counselling and NRT

Patients diagnosed with tobacco-related treatment will receive varenicline, counseling, and nicotine replacement therapy (PRN NRT). Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Varenicline

Intervention Type DRUG

Varenicline therapy will be 12-week course. On days 1-3 participants will receive 0.5mg once daily; days 4-7 receive 0.5mg twice daily and day 8 until the end of treatment receive 1mg twice daily.

High-intensity counseling

Intervention Type BEHAVIORAL

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

Nicotine Replacement Products

Intervention Type DRUG

Participants in this group will receive per required need nicotine replacement therapy.

Group : Varenicline, Intense Counselling

Patients diagnosed with tobacco-related treatment will receive varenicline and counseling. Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Varenicline

Intervention Type DRUG

Varenicline therapy will be 12-week course. On days 1-3 participants will receive 0.5mg once daily; days 4-7 receive 0.5mg twice daily and day 8 until the end of treatment receive 1mg twice daily.

High-intensity counseling

Intervention Type BEHAVIORAL

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

No nicotine replacement therapy

Intervention Type OTHER

Participants in this group will not receive per required need nicotine replacement therapy.

Group 3: Varenicline, Minimal Counselling and NRT

Patients diagnosed with tobacco-related treatment will receive varenicline, counseling, and nicotine replacement therapy (PRN NRT). Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Varenicline

Intervention Type DRUG

Varenicline therapy will be 12-week course. On days 1-3 participants will receive 0.5mg once daily; days 4-7 receive 0.5mg twice daily and day 8 until the end of treatment receive 1mg twice daily.

Low-intensity counseling

Intervention Type BEHAVIORAL

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

Nicotine Replacement Products

Intervention Type DRUG

Participants in this group will receive per required need nicotine replacement therapy.

Group 4: Varenicline, Minimal Counselling

Patients diagnosed with tobacco-related treatment will receive varenicline and counseling. Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Varenicline

Intervention Type DRUG

Varenicline therapy will be 12-week course. On days 1-3 participants will receive 0.5mg once daily; days 4-7 receive 0.5mg twice daily and day 8 until the end of treatment receive 1mg twice daily.

Low-intensity counseling

Intervention Type BEHAVIORAL

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

No nicotine replacement therapy

Intervention Type OTHER

Participants in this group will not receive per required need nicotine replacement therapy.

Group 5: Buproprion, Intense Counselling and NRT

Patients diagnosed with tobacco-related treatment will receive Buproprion, counseling, and nicotine replacement therapy (PRN NRT). Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Bupropion

Intervention Type DRUG

Patients will begin with a dose of 150 mg every morning for 3 days. Then dosage will increase to 150 mg twice daily (morning and evening), for a total daily dose of 300 mg, for 7 to 12 weeks.

High-intensity counseling

Intervention Type BEHAVIORAL

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

Nicotine Replacement Products

Intervention Type DRUG

Participants in this group will receive per required need nicotine replacement therapy.

Group 6: Buproprion, Intense Counselling

Patients diagnosed with tobacco-related treatment will receive Buproprion and counseling. Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Bupropion

Intervention Type DRUG

Patients will begin with a dose of 150 mg every morning for 3 days. Then dosage will increase to 150 mg twice daily (morning and evening), for a total daily dose of 300 mg, for 7 to 12 weeks.

High-intensity counseling

Intervention Type BEHAVIORAL

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

No nicotine replacement therapy

Intervention Type OTHER

Participants in this group will not receive per required need nicotine replacement therapy.

Group 7: Buproprion, Minimal Counselling and NRT

Patients diagnosed with tobacco-related treatment will receive Buproprion, counseling, and nicotine replacement therapy (PRN NRT). Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Bupropion

Intervention Type DRUG

Patients will begin with a dose of 150 mg every morning for 3 days. Then dosage will increase to 150 mg twice daily (morning and evening), for a total daily dose of 300 mg, for 7 to 12 weeks.

Low-intensity counseling

Intervention Type BEHAVIORAL

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

Nicotine Replacement Products

Intervention Type DRUG

Participants in this group will receive per required need nicotine replacement therapy.

Group 8: Buproprion, Minimal Counselling

Patients diagnosed with tobacco-related treatment will receive Buproprion and counseling. Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Bupropion

Intervention Type DRUG

Patients will begin with a dose of 150 mg every morning for 3 days. Then dosage will increase to 150 mg twice daily (morning and evening), for a total daily dose of 300 mg, for 7 to 12 weeks.

Low-intensity counseling

Intervention Type BEHAVIORAL

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

No nicotine replacement therapy

Intervention Type OTHER

Participants in this group will not receive per required need nicotine replacement therapy.

Group 9: Nicotine, Intense Counselling and NRT

Patients diagnosed with tobacco-related treatment will receive long acting nicotine replacement therapy (e.g. nicotine patch), counseling, and nicotine replacement therapy (PRN NRT). Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Long-acting nicotine replacement therapy

Intervention Type DRUG

Nicotine replacement therapy (NRT) patches will be used daily from 1-10 weeks depending on participant's smoking history.

High-intensity counseling

Intervention Type BEHAVIORAL

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

Nicotine Replacement Products

Intervention Type DRUG

Participants in this group will receive per required need nicotine replacement therapy.

Group 10: Nicotine, Intense Counselling

Patients diagnosed with tobacco-related treatment will receive long acting nicotine replacement therapy (e.g. nicotine patch) and counseling. Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Long-acting nicotine replacement therapy

Intervention Type DRUG

Nicotine replacement therapy (NRT) patches will be used daily from 1-10 weeks depending on participant's smoking history.

High-intensity counseling

Intervention Type BEHAVIORAL

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

No nicotine replacement therapy

Intervention Type OTHER

Participants in this group will not receive per required need nicotine replacement therapy.

Group 11: Nicotine, Minimal Counselling and NRT

Patients diagnosed with tobacco-related treatment will receive long acting nicotine replacement therapy (e.g. nicotine patch), counseling, and nicotine replacement therapy (PRN NRT). Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Long-acting nicotine replacement therapy

Intervention Type DRUG

Nicotine replacement therapy (NRT) patches will be used daily from 1-10 weeks depending on participant's smoking history.

Low-intensity counseling

Intervention Type BEHAVIORAL

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

Nicotine Replacement Products

Intervention Type DRUG

Participants in this group will receive per required need nicotine replacement therapy.

Group 12: Nicotine, Minimal Counselling

Patients diagnosed with tobacco-related treatment will receive long acting nicotine replacement therapy (e.g. nicotine patch) and counseling. Dose and frequency will be based on patient preference, smoking history and other medical factors.

Group Type EXPERIMENTAL

Long-acting nicotine replacement therapy

Intervention Type DRUG

Nicotine replacement therapy (NRT) patches will be used daily from 1-10 weeks depending on participant's smoking history.

Low-intensity counseling

Intervention Type BEHAVIORAL

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

No nicotine replacement therapy

Intervention Type OTHER

Participants in this group will not receive per required need nicotine replacement therapy.

Interventions

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Varenicline

Varenicline therapy will be 12-week course. On days 1-3 participants will receive 0.5mg once daily; days 4-7 receive 0.5mg twice daily and day 8 until the end of treatment receive 1mg twice daily.

Intervention Type DRUG

Bupropion

Patients will begin with a dose of 150 mg every morning for 3 days. Then dosage will increase to 150 mg twice daily (morning and evening), for a total daily dose of 300 mg, for 7 to 12 weeks.

Intervention Type DRUG

Long-acting nicotine replacement therapy

Nicotine replacement therapy (NRT) patches will be used daily from 1-10 weeks depending on participant's smoking history.

Intervention Type DRUG

Low-intensity counseling

A study coordinator or a member of the treatment team will provide a minimum level of initial counseling, approximately 10-20 minutes in length.

Intervention Type BEHAVIORAL

High-intensity counseling

A counselor will provide eight sessions in the first 8 weeks of the study. Up to three follow up sessions over the next 4 months of study will be encouraged, but not required.

Intervention Type BEHAVIORAL

No nicotine replacement therapy

Participants in this group will not receive per required need nicotine replacement therapy.

Intervention Type OTHER

Nicotine Replacement Products

Participants in this group will receive per required need nicotine replacement therapy.

Intervention Type DRUG

Other Intervention Names

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Chantix Wellbutrin XL, Forfivo XL, Zyban, and Aplenzin Transdermal nicotine nicotine gum, nicotine losenges, nicotine spray nicotine gum, nicotine losenges, nicotine spray

Eligibility Criteria

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Inclusion Criteria

* newly diagnosed or recurrent tobacco related malignancy
* smoked at least 1 cigarette within 4 weeks of study enrollment
* 10-pack year history of cigarette smoking
* smoked at least 1 cigarette within 1 month of cancer diagnosis
* life expectancy greater than 1 year

Exclusion Criteria

* allergy to buproprion, varenicline and transdermal medicine
* history of suicide attempt
* hospitalized for psychiatric illness within past 2 years
* history of active or uncontrolled eating disorder
* uncontrolled epilepsy or seizure disorder
* pregnant or lactating
* within 3 months of myocardial infarction
* unstable angina
* uncontrolled hypertension
* serious arrhythmia
* history of taking varenicline or buproprion within one month of enrollment
* concurrent enrollment in tobacco cessation therapy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Joseph Valentino, MD

OTHER

Sponsor Role lead

Responsible Party

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Joseph Valentino, MD

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Joseph Valentino, MD

Role: PRINCIPAL_INVESTIGATOR

University of Kentucky

Locations

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Med Center Health

Bowling Green, Kentucky, United States

Site Status

University Of Kentucky, Markey Cancer Center

Lexington, Kentucky, United States

Site Status

Owensboro Health Mitchell Memorial Cancer Center

Owensboro, Kentucky, United States

Site Status

Countries

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United States

Other Identifiers

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MCC-20-MULTI-34

Identifier Type: -

Identifier Source: org_study_id

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