Philadelphia—If cancer patients using varenicline have trouble quitting smoking, part of the issue might be that the drug course is too short, a new study suggests.

A report in the journal Psycho-Oncology found that patients have a lower relapse rate a year later if they undergo counseling sessions for 24 weeks and take the medication for the same duration versus the usual course of 12 weeks.

University of Pennsylvania–led researchers point out that, while quitting smoking has been shown to significantly improve the effectiveness of cancer treatment, nearly half of cancer patients continue to smoke after they’ve been diagnosed.

“With the stress cancer patients are under, they tend to be at higher risk of relapsing for a longer period of time,” explained senior author Brian Hitsman, PhD, associate professor of preventive medicine at Northwestern University Feinberg School of Medicine. “So we thought providing treatment for longer would be more effective.”

Study participants had a range of cancers, not just lung cancer, with 40% having active disease and the others receiving a diagnosis in the past 5 years. The 207 cancer patients who were smokers received seven counseling sessions in addition to extended treatment with the drug, marketed as Chantix. The study measured 7-day biochemically confirmed abstinence at weeks 24 and 52 while also assessing treatment adherence and side effects, adverse and serious adverse events, and blood pressure.

Results indicated that adherent participants who received extended treatment reported higher abstinence at weeks 24 and 52—60.5% and 44.2%, respectively—as opposed to standard treatment—44.7% and 27.7%, respectively.

Differences in quit rates between arms were not significant for nonadherent participants; however, the researchers noted that the higher success rate in quitting occurred only in the 43% of patients who took varenicline as directed for the full 24 weeks. For the other 57% of participants who did not take the medication as prescribed, there was no significant difference in quit rates or susceptibility of relapsing compared to the control group, who only received varenicline for the first 12 weeks.   

“We hear from cancer patients and oncologists that varenicline may cause serious side effects or that managing the stress of the disease makes addressing tobacco use among patients inappropriate,” noted first author Robert Schnoll, PhD, associate professor in the department of psychiatry and associate director for population science at the University of Pennsylvania’s Abramson Cancer Center. “But the results from this study show that this leading FDA-approved medication is effective for cancer patients, doesn’t increase patient risk and yields increased benefits for those who take the medication as prescribed.” 

“We need now to focus on how we can get more patients who smoke to use the medication and use it sufficiently if we are to see broader population-level gains,” Schnoll said.
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