Effectiveness of an Enhanced Tobacco Intervention Protocol Compared to Standard Treatment in Helping Head and Neck and Lung Cancer Patients Starting Treatment to Reduce Cigarette Use

NCT ID: NCT04694846

Last Updated: 2025-09-09

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 19 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-08-19
• Study Completion Date: 2024-08-16

Brief Summary

This trial studies how well an enhanced tobacco intervention protocol (ETIP) works compared to standard treatment in helping head and neck and lung cancer patients starting treatment to reduce cigarette use. ETIP is an evidence-based tobacco cessation program including specialized one-to-one and telehealth counseling, drug therapy, nicotine replacement therapy, and frequent patient follow up. ETIP may help reduce smoking and improve cessation in patients with head and neck squamous cell cancer or non-small cell lung cancer.

Detailed Description

PRIMARY OBJECTIVE:

I. To determine the feasibility of implementing a transdisciplinary ETIP using enrollment data and adherence to the intervention.

SECONDARY OBJECTIVE:

I. To compare smoking reduction, physiologic parameters and patient reported measures among patients in two tobacco treatment groups (ETIP and standard treatment [ST]).

TERTIARY OBJECTIVE:

I. To determine patient interest in wellness practices as a means to alter behavior and facilitate tobacco cessation.

EXPLORATORY OBJECTIVES:

I. To analyze the genetic profile, serum and tissue exosomal signatures, and immune cell profiles of both human papilloma virus (HPV) positive and negative tumor samples in patients who are never smokers, former smokers, and current smokers.

II. Compare these parameters in patients who underwent ETIP versus standard therapy.

III. To gather correlative data regarding the effects of tobacco smoke on the expression of biomarkers and the tumor microenvironment.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I (ETIP): Patients receive nicotine replacement therapy via trans-dermal patch, gum, nasal spray, inhaler or lozenges for 12 weeks in the absence of unacceptable toxicity. Patients also receive bupropion orally (PO) once daily (QD) and twice daily (BID) or varenicline PO QD and BID for 24 weeks in the absence of unacceptable toxicity. Patients undergo 3 cessation counseling sessions in person, via telehealth or phone within 7 days of enrollment into study, 1 week after established quit date and 3 weeks after establishing quit date.

ARM II (ST): Patients receive standard treatment consisting of an in-office smoking cessation recommendation by the physician and referral to a quit line.

Conditions

Lung Non-Small Cell Carcinoma; Head and Neck Squamous Cell Carcinoma

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Arm I (ETIP)

Patients receive nicotine replacement therapy via trans-dermal patch, gum, nasal spray, inhaler or lozenges for 12 weeks in the absence of unacceptable toxicity. Patients also receive bupropion PO QD BID or varenicline PO QD and BID for 24 weeks in the absence of unacceptable toxicity. Patients undergo 3 cessation counseling sessions in person, via telehealth or phone within 7 days of enrollment into study, 1 week after established quit date and 3 weeks after establishing quit date.

Group Type: EXPERIMENTAL

Nicotine Replacement

Intervention Type: DRUG

Given NRT via trans-dermal patch, gum, nasal spray, inhaler or lozenges

Bupropion Hydrochloride Controlled-release

Intervention Type: DRUG

Given PO

Varenicline

Intervention Type: DRUG

Given PO

Tobacco Cessation Counseling

Intervention Type: OTHER

Receive counseling

Questionnaire Administration

Intervention Type: OTHER

Ancillary studies

Quality of Life Assessment

Intervention Type: OTHER

Ancillary studies

Arm II SOC

Participants randomly assigned to the standard treatment (ST) group will receive an in-office smoking cessation recommendation by the physician and referral to a quit line.

Group Type: ACTIVE_COMPARATOR

Questionnaire Administration

Intervention Type: OTHER

Ancillary studies

Quality of Life Assessment

Intervention Type: OTHER

Ancillary studies

Best Practice

Intervention Type: OTHER

Receive standard treatment

Interventions

Nicotine Replacement

Given NRT via trans-dermal patch, gum, nasal spray, inhaler or lozenges

Intervention Type: DRUG

Bupropion Hydrochloride Controlled-release

Given PO

Intervention Type: DRUG

Varenicline

Given PO

Intervention Type: DRUG

Tobacco Cessation Counseling

Receive counseling

Intervention Type: OTHER

Questionnaire Administration

Ancillary studies

Intervention Type: OTHER

Quality of Life Assessment

Ancillary studies

Intervention Type: OTHER

Best Practice

Receive standard treatment

Intervention Type: OTHER

Other Intervention Names

nicotine replacement therapy, Nicotine Replacement Therapy, NRT; Bupropion HCl Controlled-release, Bupropion HCl Extended Release, Bupropion Hydrochloride Extended-Release, Forfivo XL, Wellbutrin SR, Wellbutrin XL, Zyban, Zyban; 249296-44-4, 7,8,9,10-tetrahydro-6,10-methano-6H-pyrazino(2,3-h)(3)benzazepine (2R,3R)-2,3-dihydroxybutqanedioate, Champix, Chantix, CP-526555, VARENICLINE; best practice, standard of care, standard of care, standard therapy

Eligibility Criteria

Inclusion Criteria

• Provide signed written informed consent document
• New patients opting to receive cancer care at Thomas Jefferson University Hospital (TJUH) or Methodist with suspected or newly diagnosed head and neck squamous cell carcinoma (HNSCC) or non-small cell carcinoma of the lung
• Must have a life expectancy of at least 6 months as judged by the treating physician
• Willing to discuss changing their smoking behavior
• Patients have smoked > 100 cigarettes in their lifetime and have smoked within the last 30 days
• Subjects must read and speak fluent English

Exclusion Criteria

• Patients with psychiatric disorders with indications of current uncontrolled illness, or patients currently being treated on psychiatric medications
• Patients with expected survival of less than 6 months or other medical illness that would prevent participation as determined by the treating clinician
• Patients not fluent in English will be excluded, as the counselling component of the intervention is only available in English
• Pregnant or breastfeeding women
• Severe swallowing disorders or other illness that would impede a patient's ability to swallow medications in pill form
• Patients with impaired judgement or those unable to provide informed consent
• Contraindications to nicotine replacement therapy:

• All free flap patients: Nicotine replacement therapy (NRT) and tobacco products must not be used by these patients for at least 2 weeks before and 2 weeks after free flap surgery. For planned procedures involving face and breast, tobacco and NRT use should be avoided 4 weeks before and 4 weeks after surgery
• Patients in the immediate (within 2 weeks) post myocardial infarction period or who have serious arrhythmias or unstable angina pectoris
• Patient who are hemodynamically or electrically unstable or have had orthopedic surgery or a serious fracture(s) within the past 6 weeks
• Patients with known allergy or hypersensitivity to NRT, or severe skin reactions like Steven's Johnson syndrome
• Contraindications to bupropion or varenicline:

• Pre-existing seizure disorder or conditions that increase the risk of seizures (e.g., severe head trauma, arteriovenous malformation, central nervous system (CNS) tumor (e.g., brain tumor or intracranial mass), CNS infection, severe stroke, anorexia nervosa, bulimia nervosa
• Patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs
• Concomitant use of anti-depressants
• Patients with known allergy or hypersensitivity to bupropion or varenicline, or severe skin reactions like Steven's Johnson syndrome

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Thomas Jefferson University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Sidney Kimmel Cancer Center at Thomas Jefferson Univeristy

Philadelphia, Pennsylvania, United States

Jefferson Health, Methodist Hospital

Philadelphia, Pennsylvania, United States

Countries

United States

Other Identifiers

JT 14301

Identifier Type: OTHER

Identifier Source: secondary_id

19D.866

Identifier Type: -

Identifier Source: org_study_id