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Smartphone Application versus Group Mindfulness-based Smoking Cessation Intervention for Cancer Patients and Survivors: Reach versus Effectiveness

In collaboration with researchers at St. Jude Children's Research Hospital, this project aims to test the feasibility, acceptability, and potential efficacy of a smartphone application versus an in-person mindfulness smoking cessation intervention among young cancer survivors.

Smoking is a major public health issue among cancer survivors in the U.S and their access to clinical-based cessation treatment is limited. Smoking cessation is essential after cancer diagnosis to improve clinical outcomes and lower the risk of treatment complications1. Approximately 18.7 % of cancer survivors continue to smoke even after cancer diagnosis, which can ultimately lead to the development of secondary cancers, additional comorbid conditions, and potential treatment interactions2. On the contrary, quitting smoking even after being diagnosed with cancer brings numerous advantages such as an enhanced response to treatment protocols and a decreased risk of mortality 3, 4. Few randomized controlled trials have been conducted among adult cancer survivors. Therefore, it is imperative to identify innovative smoking cessation interventions that are readily accessible and tailored to meet the unique needs of cancer survivors.

One promising strategy for smoking cessation among cancer survivors is mindfulness training (MT). MT can be divided into two components: 1) focusing attention on the present moment, and 2) cultivating an acceptance attitude toward that experience. Both components can improve individuals’ capacity to refrain from getting absorbed in maladaptive mental patterns, behaviors, and emotional reactions that lead to depression 5, 6. MT was feasible and effective in cancer survivors at improving psychological symptoms of anxiety and stress, quality of life, emotional well-being, and immunological status. Yet, MT for smoking cessation in this population and current cancer patients has not been implemented or tested. In addition to mindfulness training, our study will examine the effectiveness of an innovative mindfulness smoking cessation application “Craving to Quit” developed by our consultant Dr. Brewer, and proven to be effective among the general population 7, 8, 9. Given the increasing body of evidence indicating that technology-based interventions may be well received by cancer patients, this study will establish preliminary evidence on the feasibility and potential efficacy of mindfulness-based smoking cessation among cancer survivors using two delivery modalities, the smartphone app, and group MT compared to usual care.

Our cancer survivors study aims to tackle two major barriers to smoking cessation in cancer survivors by increasing their access to treatment through the use of smartphone technologies and mindfulness training.

We are looking for participants who meet the following eligibility criteria:

  • 18 years and older
  • Have been treated for any type of cancer
  • Have smoked cigarettes daily in the past year
  • Interested in making a quit attempt in the next 30 days
  • Own a smartphone (Apple/Android)
  • Speak English

If you are interested in participating, please apply.

References
  1. Siegel, R., DeSantis, C., Virgo, K., Stein, K., Mariotto, A., Smith, T., Cooper, D., Gansler, T., Lerro, C., Fedewa, S., Lin, C., Leach, C., Cannady, R. S., Cho, H., Scoppa, S., Hachey, M., Kirch, R., Jemal, A., & Ward, E. (2012). Cancer treatment and survivorship statistics, 2012. CA: a cancer journal for clinicians, 62(4), 220–241. https://doi.org/10.3322/caac.21149
  2. Mayer, D. K., & Carlson, J. (2011). Smoking patterns in cancer survivors. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 13(1), 34–40. https://doi.org/10.1093/ntr/ntq199
  3. Parsons, A., Daley, A., Begh, R., & Aveyard, P. (2010). Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ (Clinical research ed.), 340, b5569. https://doi.org/10.1136/bmj.b5569
  4. Browman, G. P., Wong, G., Hodson, I., Sathya, J., Russell, R., McAlpine, L., Skingley, P., & Levine, M. N. (1993). Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. The New England journal of medicine, 328(3), 159–163. https://doi.org/10.1056/NEJM199301213280302
  5. Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette Books; 2009.
  6. Malinowski P. (2013). Neural mechanisms of attentional control in mindfulness meditation. Frontiers in neuroscience, 7, 8. https://doi.org/10.3389/fnins.2013.00008
  7. Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., Minnix-Cotton, C. A., Byrne, S. A., Kober, H., Weinstein, A. J., Carroll, K. M., & Rounsaville, B. J. (2011). Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug and alcohol dependence, 119(1-2), 72–80. https://doi.org/10.1016/j.drugalcdep.2011.05.027
  8. Garrison, K. A., Pal, P., Rojiani, R., Dallery, J., O'Malley, S. S., & Brewer, J. A. (2015). A randomized controlled trial of smartphone-based mindfulness training for smoking cessation: a study protocol. BMC psychiatry, 15, 83. https://doi.org/10.1186/s12888-015-0468-z
  9. Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2013). Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 27(2), 366–379. https://doi.org/10.1037/a0028490

This study is funded by the Sylvester Cancer Comprehensive Center (SCCC) Pilot Award.

Collaborators

Portrait of Taghrid Asfar

Taghrid Asfar, M.D., M.S.P.H.

Principal Investigator
Assistant Professor, Department of Public Health Sciences
Member, Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine

tasfar@miami.edu

(305) 243-3826

Dr. Asfar has extensive experience in tobacco control research nationally and internationally. Since 2001, her tobacco control work has been funded continuously by the NIH and conducted both in the United States and the Eastern Mediterranean Region, including Syria, Lebanon, and Tunisia. This work involves epidemiological and qualitative studies of tobacco use, randomized clinical trials of smoking cessation interventions, and tobacco regulatory research in health communication approaches targeting emerging tobacco products such as e-cigarettes and hookahs. She has two overarching aims in her research: (1) improving smoking cessation treatment among socially disadvantaged and high-risk populations (i.e., low-income adults, ethnic minorities, HIV patients, cancer survivors); and (2) preventing tobacco use among youth and young adults by advancing health communication strategies, such as health warning labels. She has more than 60 peer-reviewed publications (Asfar T - Search Results - PubMed) and many of these are in leading, high impact journals in this field (i.e., Tobacco Control; Nicotine and Tobacco Research; Addiction; and the Cochrane Tobacco Addiction Group). Dr. Asfar has currently five active grants as PI including:

  • 1R01DA051836: Developing and testing health warning labels on the ENDS (electronic cigarette) device
  • 20K10 James and Esther King Biomedical Research Program: Developing and testing waterpipe-specific health warning labels targeting young people in Florida
  • R01TW010654-01: Translating Evidence and Building Capacity to Support Waterpipe Control in the Eastern Mediterranean
  • CFAR Pilot Award P30AI07396: “Mind2Quit” Developing A Mindfulness Smartphone App for Smoking Cessation for People Living with HIV
  • Sylvester Cancer Center Pilot Award P30CA240139: Smartphone Application versus In-Person Mindfulness-Based Smoking Cessation Intervention for Young Cancer Survivors: Reach versus Effectiveness
Portrait of Judson Brewer

Judson Brewer, M.D., Ph.D.

Director of Research and Innovation
Brown University

judson_brewer@brown.edu

Dr. Judson Brewer is the Director of Research and Innovation at the Mindfulness Center and associate professor in Behavioral and Social Sciences at the School of Public Health and Psychiatry at the Medical School at Brown University. He also is a research affiliate at MIT. Brewer has conducted research on the neurobiology of habits and mindfulness techniques to help individuals overcome various forms of addiction, including smoking and emotional eating. He has also written books on mindfulness, such as "The Craving Mind: From Cigarettes to Smartphones to Love – Why We Get Hooked and How We Can Break Bad Habits.". Dr. Brewer is the founder and moderater of the Craving to Quit application, where smokers can receive support, weekly tips, can track their progress of their quit journey.

  • Asfar, T., Koru-Sengul, T., Annane, D., McClure, L. A., Perez, A., Antoni, M. A., Brewer, J., & Lee, D. J. (2021). Reach versus effectiveness: The design and protocol of randomized clinical trial testing a smartphone application versus in-person mindfulness-based smoking cessation intervention among young cancer survivors. Contemporary clinical trials communications, 22, 100784. https://doi.org/10.1016/j.conctc.2021.100784
  • Asfar, T., Arheart, K. L., Koru-Sengul, T., Byrne, M. M., Dietz, N. A., Chen, C. J., & Lee, D. J. (2017). National estimates and correlates of secondhand smoke exposure in US cancer survivors. Journal of cancer survivorship : research and practice, 11(4), 469–476. https://doi.org/10.1007/s11764-017-0605-4
  • Tannenbaum, S. L., McClure, L. A., Asfar, T., Sherman, R. L., LeBlanc, W. G., & Lee, D. J. (2016). Are Cancer Survivors Physically Active? A Comparison by US States. Journal of physical activity & health, 13(2), 159–167. https://doi.org/10.1123/jpah.2014-0493
  • Asfar, T., Dietz, N. A., Arheart, K. L., Tannenbaum, S. L., McClure, L. A., Fleming, L. E., & Lee, D. J. (2016). Smoking behavior among adult childhood cancer survivors: what are we missing?. Journal of cancer survivorship : research and practice, 10(1), 131–141. https://doi.org/10.1007/s11764-015-0459-6

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