Quit2Heal: Rigorous Randomized Trial of a Smartphone Application to Help Cancer Patients Stop Smoking

PROJECT SUMMARY/ABSTRACT (DESCRIPTION)
In the US, 15% to 54% of cancer patients are cigarette smokers at the time of their diagnosis. Unfortunately,
up to 80% of smokers with cancer continue to smoke after their diagnosis. Persistent smoking after a cancer
diagnosis leads to worse clinical outcomes including decreased treatment effectiveness, increased risk of
disease recurrence, increased risk of developing second cancers, and higher mortality rates. The National
Comprehensive Cancer Network (NCCN) recommends that every cancer patient who smokes be offered an
evidence-based cessation intervention. However, limited access to effective tobacco cessation interventions is
a key barrier for promoting cessation in the context of cancer care. Needed now is a method for all smokers
with cancer to access effective and low-cost interventions designed to help this special population stop
smoking. A smartphone application (“app”) could address the access need by providing a widely available
tobacco intervention targeted for cancer patients. Apps have potentially high population level reach to cancer
patients—especially given that over three quarters (76%) of all smokers own smartphones. Despite their high
potential value, there is no evidence about: (1) the effectiveness of smartphone apps targeted to cancer
patients who smoke and (2) why these apps would be effective. Also unexplored is who is most likely to benefit
from smartphone apps targeted to cancer patients who smoke. We recently developed the first known
smartphone app (called “Quit2Heal”) specifically designed to help cancer patients quit smoking. We compared
Quit2Heal with the NCI’s QuitGuide, a widely used smoking cessation app for the general population, in a pilot
randomized controlled trial with 59 adult cancer patients who smoke. With 92% retention at the 2-month follow-
up, 30-day point prevalence quit rate was 20% for Quit2Heal vs. 7% for QuitGuide (OR=5.16; 95% CI: .71,
37.29; p=.104). Building on these knowledge gaps and encouraging results, this application proposes to
conduct a fully powered randomized controlled trial of Quit2Heal (n = 211) versus QuitGuide (n = 211), in order
to determine whether: (1) Quit2Heal has significantly higher biochemically verified 30-day point prevalence
smoking cessation at 12 months post-randomization relative to QuitGuide, and (2) Quit2Heal’s (but not
QuitGuide’s) 12-month smoking cessation outcome is significantly mediated by improvements in cancer-
related shame, stigma, depression, anxiety, and knowledge about consequences of smoking vs. quitting after
cancer diagnosis. The project will also explore whether these baseline factors moderate the cessation
outcome: (a) cancer type, (b) stage of cancer, (c) time since diagnosis, (d) demographics, (e) having a
partner/spouse who smokes, (f) whether participant was advised to quit by oncologist, and (g) recruitment
source. If the aims are achieved, this project will advance scientific knowledge about the effectiveness of apps
for helping cancer patients quit smoking. Positive results would provide an effective and highly accessible
public health intervention for cancer patients.

Grant Number: 5R01CA253975-06
NIH Institute/Center: NIH
Principal Investigator: Jonathan Bricker