A bupropion smoking cessation clinical trial for cancer patients
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Many cancer patients continue to smoke post diagnosis, yet there have been few smoking cessation trials for this population. Depression, which is prevalent among cancer patients, may be a barrier to cessation.
This double-blind placebo-controlled trial randomized 246 cancer patients to 9 weeks of placebo or bupropion, stratifying by pre-treatment depression symptoms. In addition, all patients received transdermal nicotine and behavioral counseling. Primary outcomes were 7-day point-prevalence abstinence, biochemically confirmed, at the end of treatment (Week 12), and at 6 months post quit day (Week 27). Additional outcomes included: withdrawal, affect, quality of life, compliance, and side effects.
There was no main effect of bupropion vs. placebo on abstinence (Odds Ratio [OR] = 1.36, 95% CI: 0.38–4.81, p = .64). Patients with depression symptoms reported significantly lower abstinence rates vs. patients without depression symptoms (OR = .14, 95% CI: 0.02–0.80, p = .03). Bupropion increased abstinence rates, vs. placebo, more for participants with depression vs. those without depression symptoms. For patients with depression symptoms, bupropion reduced withdrawal symptoms and improved quality of life vs. placebo.
For patients with depression symptoms, bupropion increases abstinence rates, lowers withdrawal, and increases quality of life. However, abstinence rates among patients with depression symptoms were low vs. patients without depression symptoms, who exhibited similar abstinence rates when treated with bupropion or transdermal nicotine and counseling alone. These results can guide future smoking cessation intervention studies with cancer patients.
KeywordsCancer patients Smoking Bupropion Depression
The authors would like to thank Ms. Jeanne Pomenti for assisting with the preparation of this manuscript. This study was funded by grant R01 CA95678 from the National Cancer Institute. Transdermal nicotine patches were provided free-of-charge by GlaxoSmithKline. All sites provided Institutional Review Board approval. All patients provided informed consent for this study.
- 23.van Wilgen CP, Dijkstra PU, Stewart RE et al (2006) Measuring somatic symptoms with the CES-D to assess depression in cancer patients after treatment: comparison among patients with oral/oropharyngeal, gynecological, colorectal, and breast cancer. Psychosomatics 47:465–470CrossRefPubMedGoogle Scholar
- 39.Fiore MC, Jaén CR, Baker TB, et al (2008) Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, May 2008Google Scholar
- 40.Glaxo_Wellcome (1999) Bupropion hydrochloride sustained-release tablets prescribing information. Research Triangle Park, North Carolina, USAGoogle Scholar
- 44.Hughes JR, Stead LF, Lancaster T (2007) Antidepressants for smoking cessation. Cochrane Database Syst Rev: CD000031Google Scholar
- 45.Rigotti NA, Munafo MR, Stead LF (2007) Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev: CD001837Google Scholar
- 52.Dy SM, Lorenz KA, Naeim A et al (2008) Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. J Clin Oncol 26:2886–2895Google Scholar