More than half of individuals with serious mental illness (SMI) smoke, contributing to premature cancer mortality. A cancer diagnosis provides an opportunity to assist with smoking cessation; however, supportive oncology trials frequently exclude patients with SMI. To fill this gap, we examined differences in engagement and tobacco cessation in a pragmatic clinical trial.

We recruited 303 participants from two National Cancer Institute–designated Comprehensive Cancer Centers, of which 10% had prior diagnoses of SMI (major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders). We compared self-reported smoking behaviors, patient attitudes and beliefs about cessation, and rates of trial completion, engagement, and smoking abstinence among recently diagnosed patients with cancer with and without SMI. Six months after trial completion, we completed qualitative interviews on barriers and facilitators to tobacco cessation in a random sample of participants with SMI.

Trial participants with SMI had similar motivation to quit smoking as those without SMI. Additionally, participants with SMI had a similar ability to engage in a tobacco treatment trial (6.5 counseling sessions completed v 7.3 sessions) and benefit from tobacco treatment as those without SMI (32.3% v 27.8% 6-month quit rates).

Patients with cancer and SMI were able to engage in and benefit from a tobacco cessation trial integrated into cancer care. A cancer diagnosis provides an opportunity to assist patients with SMI with smoking cessation referrals and treatment. Pragmatic supportive oncology trials that include a diverse population of adults with SMI are needed to inform care delivery and improve cancer outcomes for patients with SMI and cancer.

This research study was funded by the National Cancer Institute (5 R01 CA166147-05; 1 K24 CA197382, K08CA230185) and by Pfizer (IIR WS581690). E.R.P. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conception and design: Elyse R. Park, Jamie S. Ostroff

Administrative support: Colin Ponzani

Provision of study materials or patients: Jamie S. Ostroff

Collection and assembly of data: Elyse R. Park, Jamie S. Ostroff, Colin Ponzani, Susan Regan

Data analysis and interpretation: Eleanor B. Steffens, Elyse R. Park, Alona Muzikansky, Joanna M. Streck, Jamie S. Ostroff, Autumn W. Rasmussen, Giselle K. Perez, Nancy A. Rigotti, Kelly E. Irwin

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Patients With Serious Mental Illness Can Engage in Tobacco Treatment Trials and Tobacco Cessation Interventions During Cancer Treatment

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

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Elyse R. Park

Honoraria: UpToDate

Jamie S. Ostroff

Patents, Royalties, Other Intellectual Property: UptoDate

Nancy A. Rigotti

Consulting or Advisory Role: Achieve Life Sciences

Research Funding: Achieve Life Sciences (Inst)

Other Relationship: UpToDate

No other potential conflicts of interest were reported.