Personalized counseling program helps cervical cancer survivors quit smoking

A new study led by UCLA researchers suggests that a personalized counseling program can significantly help women who have survived cervical precancer or cervical cancer to quit smoking - and does so at a cost that researchers say represents good value for healthcare systems.

The findings, published in JAMA Network Open, show that the specialized program, called Motivation and Problem-Solving (MAPS), which combines standard nicotine replacement therapy with up to six individualized counseling sessions over a year, helped twice as many women quit smoking compared to women who had standard smoking cessation support.

Smoking is a major risk factor for cancer recurrence and other health problems, so quitting is especially important for these survivors."

Tina Shih, PhD, director of the Cancer Health Economics Research Program at the UCLA Health Jonsson Comprehensive Cancer Center, and senior author of the study

Cervical cancer survivors have some of the highest smoking rates among all cancer survivor groups. More than 30% continue to smoke after diagnosis, despite evidence that smoking increases the risk of recurrence, second cancers, reduced survival and poorer quality of life. Yet, many cervical cancer survivors struggle to quit.

"Many struggle with low motivation and confidence in quitting, stress and other triggers, and some do not realize how strongly smoking is linked to their cancer, which is why tailored support can make such a difference," said Shih, who is also a professor of Health Economics in the department of radiation oncology at the David Geffen School of Medicine at UCLA. "To date, there are very few programs designed specifically for them."

To determine whether more intensive support would improve quit rates and be worth the added cost for healthcare systems, researchers at UCLA and Moffitt Cancer Center conducted a randomized clinical trial involving 194 women with a history of cervical intraepithelial neoplasia or cervical cancer who were current smokers. All participants received 12 weeks of nicotine replacement therapy, including patches and lozenges. Half were assigned to standard treatment, which included self-help materials and a referral to a state quitline, while the other half also received up to six personalized MAPS counseling sessions over 12 months. These counseling sessions focus on motivation, coping with cravings, stress management, relapse prevention, and broader lifestyle support, including nutrition and physical activity.

After 12 months, 26.5% of women in the MAPS group had quit smoking, compared with 12.5% in the standard treatment group, more than double the quit rate. The team at UCLA evaluated the cost-effectiveness of smoking cessation interventions assessed in this trial and found that although MAPS cost more per participant than standard tobacco treatment, about $523 per person compared with $389 for standard care, the personalized counseling represented good value. At 12 months, MAPS cost approximately $921 for each additional person who quit smoking compared with standard treatment, a figure considered cost-effective relative to other smoking cessation programs for cancer patients. The probability that the program was cost-effective exceeded 90% at commonly accepted willingness-to-pay thresholds, suggesting that cancer centers and health systems could adopt the approach without substantial financial strain.

At 18 months, six months after counseling ended, quit rates declined in the MAPS group to 14.3%, compared with 12.5% in the standard treatment group. As a result, the incremental cost per quit increased to about $7,458. Researchers noted that women who were more engaged in the counseling sessions had even stronger and more sustained results.

Importantly, women who completed four or more counseling sessions, which is considered high engagement, had better outcomes and more favorable cost-effectiveness results than those who attended fewer sessions. Among these highly engaged participants, the cost per quit remained favorable even at 18 months.

"We found that the MAPS program not only helped more women quit, but did so at a cost that compares favorably with many other smoking cessation programs at cancer centers," said Shih. "The findings provide strong evidence that cancer centers that implement MAPS can achieve meaningful improvements in smoking cessation among cervical cancer survivors at a reasonable cost. However, more investment is needed to extend the duration of MAPS treatment and boost participant engagement to prevent relapse and sustain abstinence long-term."

The study's first author is Xiaoyu Liu, a PhD candidate at the Department of Health Policy and Management, UCLA Fielding School of Public Health. 

The study was supported by a grant from the National Cancer Institute.