A bupropion smoking cessation clinical trial for cancer patients.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Schnoll
Robert A
RA
Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA, 19104, USA. schnoll@mail.med.upenn.edu
Martinez
Elisa
E
Tatum
Kristina L
KL
Weber
Dorothy M
DM
Kuzla
Natalie
N
Glass
Marcella
M
Ridge
John A
JA
Langer
Corey
C
Miyamoto
Curtis
C
Wileyto
E Paul
EP
Leone
Frank
F
D000279:Administration, Cutaneous; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use*; D003863:Depression; D003866:Depressive Disorder / Q000453:epidemiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D015995:Prevalence; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine