Repetitive Transcranial Magnetic Stimulation for Tobacco Treatment in Cancer Patients: A Preliminary Report of a One-Week Treatment

Abstract

Background: Smoking cessation represents a significant opportunity to improve cancer survival rates, reduces the risk of cancer treatment complications, and improves quality of life. However, about half of cancer patients who smoke continue to smoke despite the availability of several treatments. Previous studies demonstrate that repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) decreases cue craving, reduces cigarette consumption, and increases the quit rate in tobacco use disorder. We investigated whether 5 sessions of rTMS can be safely and efficaciously used for smoking cessation in cancer patients.

Methods: We enrolled 11 treatment-seeking smokers with cancer (>5 cigarettes per day) in a randomized, double-blind, sham-controlled proof-of-concept study. Participants received 5 daily sessions of active 10 Hz rTMS of the left DLPFC (3000 pulses per session) or sham rTMS and were followed up for 1 month via phone assessments. Main outcomes included reductions in the number of smoked-cigarettes per day (primary) and craving (secondary). Adverse effects were reported daily by participants.

Results: Seven of 11 participants completed 5 sessions of rTMS over one week. Compared to sham treatment (n = 4), the active rTMS (n = 3) exhibited modest effects overtime on smoking (Cohen's f ² effect size of 0.16) and large effects on cue craving (Cohen's f ² = 0.40). No serious side effects related to rTMS were reported in the treatment.

Conclusions: Five sessions of daily rTMS over the left DLPFC might benefit cancer patients who smoke cigarettes. However, further evidence is needed to determine with more certainty its therapeutic effect and adverse effects for cancer patients who smoke cigarettes.

Figure 1

One-week rTMS reduces cigarette consumption and cue-craving in cancer patients. (a) rTMS reduced CPD to a significantly greater degree than sham rTMS (p < 0.005) (sham: blue; active: red). Post hoc, there is a difference between the two treatments at 2^nd visit, ^∗p < 0.05. (b) rTMS reduced cue-craving to a significantly greater degree than sham rTMS (p < 0.0001) (sham: blue; active: red; presession measure: solid; postsession measure: dashes).