JMIR Publications

ABSTRACT

Background:

Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone applications (“apps”) can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis.

Objective:

We used an agile, user-centered design framework to develop a fully automated smartphone app called “Quit2Heal”, that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with NCI’s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnoses were lung (36%) and breast (17%). The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P =.15). Clinical Trials.gov Registration Number: NCT03600038.

Methods:

We used an agile, user-centered design framework to develop a smartphone app called “Quit2Heal”, specifically designed to help cancer patients stop smoking by providing skills training and stories from cancer survivors that focus on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with NCI’s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. Participants were 75% female and 78% White. The most common types of cancer diagnoses were lung (36%) and breast (17%). The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P =.15).

Results:

Compared to QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90% vs. 65%; P =.047), were more likely to report that their assigned app was made for someone like them (86% vs. 62%; P = .04), and opened their app more times during the 2-month trial period, although this difference was not statistically significant [M = 10.0 (SD = 14.40) vs. 6.1 (SD =5.3); P =.33]. Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20% for Quit2Heal vs. 7% for QuitGuide (OR=5.16; 95% CI: 0.71, 37.29; p=.104). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression and anxiety, though these were not statistically significant (all P >.05).

Conclusions:

In a pilot trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full scale RCT with longer follow-up and larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Clinical Trial: NCT03600038