A Randomized Controlled Study of Integrated Smoking Cessation in a Lung Cancer Screening Program

Abstract

Introduction: Smoking cessation activities incorporated into lung cancer screening programs have been broadly recommended, but studies to date have not shown increased quit rates associated with cessation programs in this setting. We aimed to determine the effectiveness of smoking cessation counseling in smokers presenting for lung cancer screening. Methods: This study is a randomized control trial of an intensive telephone-based smoking cessation counseling intervention incorporating lung cancer screening results versus usual care (information pamphlet). All active smokers enrolled in the Alberta Lung Cancer Screening Study cohort were randomized on a 1:1 ratio with a primary endpoint of self-reported 30-day abstinence at 12 months. Results: A total of 345 active smokers participating in the screening study were randomized to active smoking cessation counseling (n ¼ 171) or control arm (n ¼ 174). Thirty-day smoking abstinence at 12 months postrandomization was noted in 22 of 174 (12.6%) and 24 of 171 (14.0%) of participants in the control and intervention arms, respectively, a 1.4% difference (95% confidence interval:-5.9 to 8.7, p ¼ 0.7). No statistically significant differences in 7-day or point abstinence were noted, nor were differences at 6 months or 24 months. Conclusions: A telephone-based smoking cessation counseling intervention incorporating lung cancer screening results did not result in increased 12-month cessation rates versus written information alone in unselected smokers undergoing lung cancer screening. Routine referral of all current smokers to counseling-based cessation programs may not improve long-term cessation in this patient cohort. Future studies should specifically focus on this subgroup of

Incorporating lung cancer screening education into tobacco cessation group counseling

“…In the United States, tobacco cessation services are required for sites in order for reimbursement to be given by the Center for Medicare and Medicaid Services (CMS). A number of studies have been published evaluating different modalities of tobacco cessation counseling for patients undergoing LCS [16][17][18][19][20] .…”

Smoking Cessation and Low-Dose Computed Tomography Screening: A Necessary Pair

“…Plenty of room exists for improvement and progress, not only in the setting of LDCT screening, but in general medicine clinics, cancer hospitals, and society at large. Results from Tremblay et al 8 assist in refining efforts to improve smoking cessation in combination with LDCT and support the need for continued investigation on effective methods to improve overall health.…”

“…Although Tremblay et al 8 did not find increased abstinence with targeted phone interventions in the context of LDCT screening, it is critical to retain perspective on the magnitude of clinical benefit provided by smoking cessation. The financial and societal effects of continued smoking are profound with annual estimates of $1 trillion in economic damages internationally and nearly $300 billion in health care costs in the United States alone.…”

“…In the accompanying article, Tremblay et al 8 report that telephone-based smoking cessation counselling did not improve quit rates in active smokers undergoing LDCT screening. The study is an important contribution for the oncology field and helps advance the research agenda on smoking cessation in patients at high risk of cancer.…”

“…A notable strength of the study by Tremblay et al 8 was the opt-out strategy used in the intervention arm. This opt-out approach was innovative and showed the powerful ability to increase contact rates by providing smoking cessation counseling as the "default."…”