A Dialectical Behavior Therapy Skills Training Intervention for Cigarette Smoking by Patients with Cancer: Focused Qualitative Inquiry Prior to Feasibility Trial

BackgroundDespite evidence that quitting smoking improves cancer treatment and outcomes, about one in eight patients with cancer smokes cigarettes. Barriers to quitting for patients with cancer include psychological distress such as anxiety and hopelessness and difficulties with emotion regulation. Patients who continue to smoke may benefit from targeted therapies beyond motivational and cognitive approaches common to standard-of-care smoking cessation treatment. To improve patient self-efficacy for quitting, we developed an eight-session virtual group intervention to teach patients skills in mindfulness, emotion regulation, and distress tolerance. Our intervention uses Dialectical Behavior Therapy - Skills Training (DBT-ST), a psychotherapy that has been applied successfully to improve coping skills and outcomes for patients with substance use disorders and patients with breast cancer but has not been applied to smoking among cancer populations.

AimTo improve our intervention prior to testing with a feasibility clinical trial, we performed a focused qualitative inquiry of patients with cancer who had smoking histories and of their clinicians.

MethodsWe conducted semi-structured qualitative interviews with patients with cancer who smoked or had quit (n=8) and oncology physicians, psychotherapists, and nurses (n=9). After reaching data saturation within each participant group, we analyzed interviews using thematic analysis and compared findings within and across participant groups.

ResultsPatients and clinicians strongly supported the intervention for smoking cessation, especially the group format and teaching DBT-ST skills for being present, managing emotions, and handling stress. They shared conflicting opinions on other components such as the virtual setting and whether to include patients not ready to quit. Additional perceived benefits were improved quality of life, decreased anxiety and depression, and acquisition of universal skills for managing lifes challenges.

ConclusionsThese results indicate early enthusiasm and promise for our DBT-ST intervention for patients with cancer who smoke cigarettes, while suggesting modifications prior to the feasibility trial.

HighlightsPeople with cancer who continue to smoke cigarettes - about one in eight patients - are more likely to have worse outcomes and shorter lifespans than patients who quit or have never smoked. We designed an innovative program to help people with cancer learn new skills to manage intense stress, calm intense emotions, and be more present to their experiences rather than using smoking to cope.

To improve the program in advance of a clinical trial, we described it to patients with cancer and cancer clinicians for their reactions and opinions.

Overall, our participants were enthusiastic about our program, especially the skills we were planning to teach, while also offering many helpful suggestions that we will use to modify the program.