PURPOSE: More than half of individuals with serious mental illness (SMI) smoke, contributing to premature cancer mortality. A cancer diagnosis provides an opportunity to assist with smoking cessation; however, supportive oncology trials frequently exclude patients with SMI. To fill this gap, we examined differences in engagement and tobacco cessation in a pragmatic clinical trial. METHODS: We recruited 303 participants from two National Cancer Institute–designated Comprehensive Cancer Centers, of which 10% had prior diagnoses of SMI (major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders). We compared self-reported smoking behaviors, patient attitudes and beliefs about cessation, and rates of trial completion, engagement, and smoking abstinence among recently diagnosed patients with cancer with and without SMI. Six months after trial completion, we completed qualitative interviews on barriers and facilitators to tobacco cessation in a random sample of participants with SMI. RESULTS: Trial participants with SMI had similar motivation to quit smoking as those without SMI. Additionally, participants with SMI had a similar ability to engage in a tobacco treatment trial (6.5 counseling sessions completed v 7.3 sessions) and benefit from tobacco treatment as those without SMI (32.3% v 27.8% 6-month quit rates). CONCLUSION: Patients with cancer and SMI were able to engage in and benefit from a tobacco cessation trial integrated into cancer care. A cancer diagnosis provides an opportunity to assist patients with SMI with smoking cessation referrals and treatment. Pragmatic supportive oncology trials that include a diverse population of adults with SMI are needed to inform care delivery and improve cancer outcomes for patients with SMI and cancer.

Purpose Group-based mind–body interventions such as the Stress Management and Resiliency Training-Relaxation Response Resiliency Program (SMART-3RP) hold promise for enhancing resiliency among cancer survivors. Mechanisms underlying improvements in psychological outcomes are theoretically established but remain unexamined empirically. Methods Adult cancer survivors ( n = 105) participating in the SMART-3RP completed surveys of resiliency and five hypothesized mediators: coping (ability to relax physical tension and assertive social support-seeking), mindfulness, positive affect, and worry. Pre-post intervention changes were assessed using repeated-measures t -tests. Bivariate correlations between change scores and a more conservative within-person parallel mediation model tested covariance between resiliency and mediators. Results Participants experienced moderate to large improvements in all patient-reported outcomes (ds = 1.01–0.46). Increased resiliency was significantly associated with increases in mindfulness, positive affect, and assertive social support-seeking ( r s = 0.36–0.50); smaller associations with increased relaxation and decreased worry were not significant. Mindfulness and positive affect explained the largest proportion of variance in resiliency increase in the full multivariate model. Conclusions Cancer survivors completing the SMART-3RP had increased resiliency, which was associated with improvements in mindfulness, positive affect, and the ability to assertively seek social support. Enhancing mindfulness and positive affect were critical components for enhancing resiliency. Implications for resiliency interventions with cancer survivors are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07022-5.

Background Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. Methods/design This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. Discussion This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. Trial registration ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.