A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting

Abstract

Background Lung cancer mortality is reduced via low-dose CT screening and treatment of early-stage disease. Evidence-based smoking cessation treatment in the lung screening setting can further reduce mortality. We report the results of a cessation trial from the NCI’s SCALE collaboration. Methods Eligible patients (N = 818) aged 50–80 were randomized (May 2017-January 2021) to the Intensive vs. Minimal arms (8 vs. 3 phone sessions plus 8 vs. 2 weeks of nicotine patches, respectively). Bio-verified (primary) and self-reported 7-day abstinence rates were assessed 3-, 6-, and 12-months post-randomization. Logistic regression analyses evaluated the effects of study arm. All statistical tests were two-sided. Results Participants reported 48.0 (SD = 17.2) pack-years and 51.6% were not ready to quit in < 30 days. Self-reported 3-month quit rates were significantly higher in the Intensive vs. Minimal arm (14.3% vs. 7.9%; OR = 2.00, 95% confidence interval [CI] = 1.26,3.18). Bio-verified abstinence was lower but with similar relative differences between arms (9.1% vs. 3.9%; OR = 2.70, 95% CI = 1.44, 5.08). Compared to the Minimal arm, the Intensive arm was more effective among those with greater nicotine dependence (OR = 3.47, 95% CI = 1.55, 7.76), normal screening results (OR = 2.58, 95% CI = 1.32, 5.03), high engagement in counseling (OR = 3.03, 95% CI = 1.50, 6.14) and patch use (OR = 2.81, 95% CI = 1.39, 5.68). Abstinence rates did not differ significantly between arms at 6-months (OR = 1.2, 95% CI = 0.68, 2.11) or 12-months (OR = 1.4, 95% CI = 0.82, 2.42). Conclusions Delivering intensive telephone counseling and nicotine replacement with lung screening is an effective strategy to increase short-term smoking cessation. Methods to maintain short-term effects are needed. Even with modest quit rates, integrating cessation treatment into lung screening programs may have a large impact on tobacco-related mortality.

Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

“…We used data collected from a randomized clinical trial in the lung cancer screening setting. One-half of the trial participants were not ready to quit within the next 30 days ( 37 ), similar to the US population of smokers eligible for lung cancer screening ( 5 , 12 ). Therefore, this study provides unbiased and generalizable results on the efficacy and costs of a smoking cessation intervention in the lung cancer screening setting.…”

“…The trial data were used to estimate cessation rates among lung screening participants ( 37 ). Because the trial did not have a no-intervention arm, we used self-reported data from the Tobacco Use Supplement to the Current Population Survey 2018-2019 to estimate rates expected without specific intervention ( Supplementary Methods ; Supplementary Table 1 , available online) ( 44 ).…”

“…We used data from a multisite national randomized trial ( 36 , 37 ) conducted within the National Cancer Institute–funded Smoking Cessation at Lung Examination initiative to evaluate the short-term societal costs of telephone counseling with nicotine replacement among individuals receiving lung cancer screening. Trial data were extended using a well-established Cancer Intervention and Surveillance Modeling Network (CISNET) microsimulation model to project the lifetime impact ( 12-14 , 38 ).…”

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

“…Taylor et al, (37) randomised 92 smokers attending screening to receive 6 sessions of telephone behavioural counselling after participants had attended screening and received results, or a written information booklet (UC). A subsequent paper from that group randomised 818 smokers to receive intensive (8 telephone counselling sessions plus 8 weeks of NRT patch) or less intensive (3 counselling sessions, plus 2 weeks NRT patch), delivered 13 days post LDCT scan (38). Williams et al, (41) randomised 315 smokers attending a TLHC to receive 6 sessions of telephone behavioural support starting immediately, with pharmacotherapy prescriptions within 48 hours of participating in the TLHC, or VBA to quit and signposting to local services (UC).…”

“…To analyse the effectiveness of smoking cessation interventions, we performed a metaanalysis on included RCT which compared quit rate between smoking cessation and usual care groups delivered in a screening context. Meta-analysis of 8 RCTs eligible for inclusion (32,33,(35)(36)(37)(38)(39)41) (n= 1,984) demonstrated that providing a smoking cessation intervention improved quit rates among current smokers enrolled in screening programmes compared with usual care (OR: 2.01, 95%: 1.49-2.72 p<0.001), Figure 2. We included data from Arm 1 (e-cigarette with nicotine) and Arm 3 (usual care) from the Lucchiari et al, (35) study, as this best answered the research question.…”