Pairing smoking‐cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco

Abstract

Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation.

Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: A randomized clinical trial

“…4 Although there are multiple cessation interventions with proven effectiveness, 5 presently none have demonstrated efficacy in the lung cancer screening (LCS) setting. 6 …”

Strategies for smoking cessation among high risk populations to prevent lung cancer

“…Instead, pairing evidence-based smoking cessation interventions (e.g., counseling and pharmacotherapy) with screening is likely to increase reductions in smoking [14] and result in improved downstream clinical outcomes for screening patients. The ACCP and American Thoracic Society published a policy statement indicating that one of the critical components of a comprehensive lung screening program is integration with a smoking cessation program [15], and the Association for the Treatment of Tobacco Use and Dependence/SRNT have encouraged incorporation of smoking cessation services into lung cancer screening [16]. Lung cancer screening provides an opportunity to intervene with smoking in a high-risk population that would not otherwise seek smoking cessation services, and lung cancer screening offers a modality through which access to these services can be expanded.…”

“…Lung cancer screening provides an opportunity to intervene with smoking in a high-risk population that would not otherwise seek smoking cessation services, and lung cancer screening offers a modality through which access to these services can be expanded. Currently, there is little data on the optimal method and intensity to deliver cessation treatment in the screening environment [16]. Additional research is required to identify optimal methods, but implementation of the treatment approaches outlined in the U.S. Public Health Service’s clinical practice guidelines [4] should be considered for all screening programs.…”

Stakeholder Research Priorities for Smoking Cessation Interventions within Lung Cancer Screening Programs. An Official American Thoracic Society Research Statement

“…The National Institutes of Health (NIH); the National Academies of Science, Engineering, and Medicine; the Association for the Treatment of Tobacco Use and Dependence; and the Society for Research on Nicotine and Tobacco have all highlighted the need for research on optimal strategies to integrate smoking cessation interventions within LDCT screening programs (15–17). In this research statement, we discuss the methodology and development of a stakeholder-endorsed research priority agenda relating to tobacco dependence treatment in LDCT screening programs.…”