The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence
Introduction: The degree to which smokers quit successfully with varenicline is strongly associated with their adherence to the medication regimen. Thus, measuring varenicline adherence to identify smokers needing additional intervention is a priority. Few studies, however, have examined the validit...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-12-01
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| Series: | Addictive Behaviors Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352853218300919 |
| _version_ | 1818502868847558656 |
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| author | Grace Crawford Nancy Jao Annie R. Peng Frank Leone Ravi Kalhan Rachel F. Tyndale Jessica Weisbrot Brian Hitsman Robert Schnoll |
| author_facet | Grace Crawford Nancy Jao Annie R. Peng Frank Leone Ravi Kalhan Rachel F. Tyndale Jessica Weisbrot Brian Hitsman Robert Schnoll |
| author_sort | Grace Crawford |
| collection | DOAJ |
| description | Introduction: The degree to which smokers quit successfully with varenicline is strongly associated with their adherence to the medication regimen. Thus, measuring varenicline adherence to identify smokers needing additional intervention is a priority. Few studies, however, have examined the validity of self-reported varenicline adherence, using a biological assessment of adherence as a reference. No study has examined this issue among cancer patients trying to quit smoking, who may show unique patterns of adherence given their medical comorbidity. Methods: This study used data from 76 cancer patients who received varenicline and provided self-reported varenicline adherence data (pill count) and a blood sample to determine varenicline metabolites 4 weeks after initiating varenicline. Results: Receiver operating characteristic (ROC) curve analyses of plasma varenicline levels showed that 4 ng/ml was the optimal cut-point for differentiating adherence with significant (p's < 0.04) area under the curve values, ranging from 0.73–0.80 for 3-day, 7-day, and 4-week self-reported pill count; specificity values ranged from 0.63–0.78 and sensitivity values ranged from 0.82–0.94. Using this cut-point, adherence was high (88%). However, plasma varenicline levels were weakly correlated with 3-day and 4-week pill count and total pill count (12 weeks) was not correlated with plasma varenicline levels. Patients with head and neck cancer, gastrointestinal cancer, and more advanced disease showed lower varenicline adherence and lower plasma varenicline. Conclusions: Using the 4 ng/ml cut-point, this study suggests validity of short-term self-reported varenicline adherence among cancer patients undergoing tobacco dependence treatment in contrast to studies in the general population, which supported 12-week pill count. Keywords: Adherence, Varenicline, Smoking cessation, Tobacco dependence |
| first_indexed | 2024-12-10T21:16:11Z |
| format | Article |
| id | doaj.art-b64e9067a28a405fa913e12689eddc87 |
| institution | Directory Open Access Journal |
| issn | 2352-8532 |
| language | English |
| last_indexed | 2024-12-10T21:16:11Z |
| publishDate | 2018-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Addictive Behaviors Reports |
| spelling | doaj.art-b64e9067a28a405fa913e12689eddc872022-12-22T01:33:17ZengElsevierAddictive Behaviors Reports2352-85322018-12-0184650The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependenceGrace Crawford0Nancy Jao1Annie R. Peng2Frank Leone3Ravi Kalhan4Rachel F. Tyndale5Jessica Weisbrot6Brian Hitsman7Robert Schnoll8Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA 19104, USADepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USADepartment of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S-1A8, CanadaDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, Suite 251 Wright-Saunders Building, Philadelphia, PA 19104, USADepartment of Medicine, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 1400, Chicago, IL 60611, USADepartment of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S-1A8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T-1R8, CanadaDepartment of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA 19104, USADepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USADepartment of Psychiatry and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA; Corresponding author at: Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA 19104, USA.Introduction: The degree to which smokers quit successfully with varenicline is strongly associated with their adherence to the medication regimen. Thus, measuring varenicline adherence to identify smokers needing additional intervention is a priority. Few studies, however, have examined the validity of self-reported varenicline adherence, using a biological assessment of adherence as a reference. No study has examined this issue among cancer patients trying to quit smoking, who may show unique patterns of adherence given their medical comorbidity. Methods: This study used data from 76 cancer patients who received varenicline and provided self-reported varenicline adherence data (pill count) and a blood sample to determine varenicline metabolites 4 weeks after initiating varenicline. Results: Receiver operating characteristic (ROC) curve analyses of plasma varenicline levels showed that 4 ng/ml was the optimal cut-point for differentiating adherence with significant (p's < 0.04) area under the curve values, ranging from 0.73–0.80 for 3-day, 7-day, and 4-week self-reported pill count; specificity values ranged from 0.63–0.78 and sensitivity values ranged from 0.82–0.94. Using this cut-point, adherence was high (88%). However, plasma varenicline levels were weakly correlated with 3-day and 4-week pill count and total pill count (12 weeks) was not correlated with plasma varenicline levels. Patients with head and neck cancer, gastrointestinal cancer, and more advanced disease showed lower varenicline adherence and lower plasma varenicline. Conclusions: Using the 4 ng/ml cut-point, this study suggests validity of short-term self-reported varenicline adherence among cancer patients undergoing tobacco dependence treatment in contrast to studies in the general population, which supported 12-week pill count. Keywords: Adherence, Varenicline, Smoking cessation, Tobacco dependencehttp://www.sciencedirect.com/science/article/pii/S2352853218300919 |
| spellingShingle | Grace Crawford Nancy Jao Annie R. Peng Frank Leone Ravi Kalhan Rachel F. Tyndale Jessica Weisbrot Brian Hitsman Robert Schnoll The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence Addictive Behaviors Reports |
| title | The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence |
| title_full | The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence |
| title_fullStr | The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence |
| title_full_unstemmed | The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence |
| title_short | The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence |
| title_sort | association between self reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence |
| url | http://www.sciencedirect.com/science/article/pii/S2352853218300919 |
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