Pilot study testing varenicline combined with a behavioral intervention for promoting smoking cessation and pain management among patients with cancer

Purpose Many patients with cancer smoke and also experience pain. Smoking offers short-term pain relief but exacerbates pain long-term. We pilot tested the feasibility, acceptability, and preliminary efficacy of adding varenicline to a combined behavioral treatment that addresses smoking cessation and pain management. Methods We conducted a single arm pilot study in which we provided varenicline paired with a 4-session behavioral treatment that uses the same techniques to help people quit smoking and manage their pain. Our primary outcome was 7-day point prevalence abstinence at 6-months post-randomization. Results We recruited 19 patients with cancer. 80% of the patients who received the intervention rated it as extremely useful (4 or 5 out of 5) in helping them quit smoking; 60% rated it as helpful in managing their pain. Further, 81% would recommend the program to other patients with cancer. Over one-third (35%) reported biochemically validated abstinence at 6 months post-randomization. We did not see improvements in reported pain but did see improvements in pain self-efficacy. Conclusions Our pilot data suggest the feasibility, acceptability, and preliminary efficacy of this approach for promoting cessation. We need to refine aspects to help address pain, yet addressing pain in addition to smoking cessation might motivate more patients with cancer to join the program. The next step is to conduct a large randomized controlled trial to fully test the efficacy of the combined behavioral program with varenicline. Implications for Cancer Survivors: A combined smoking cessation and pain program paired with varenicline might help patients with cancer quit smoking.