Predictors of Enrollment of Older Smokers in Six Smoking Cessation Trials in the Lung Cancer Screening Setting: The Smoking Cessation at Lung Examination (SCALE) Collaboration

Abstract

Significance Increased rates of smoking cessation will be essential to maximize the population benefit of low-dose CT screening for lung cancer. The NCI’s Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight randomized trials, each assessing evidence-based interventions among smokers undergoing lung cancer screening (LCS). We examined predictors of trial enrollment to improve future outreach efforts for cessation interventions offered to older smokers in this and other clinical settings. Methods We included the six SCALE trials that randomized individual participants. We assessed demographics, intervention modalities, LCS site and trial administration characteristics, and reasons for declining. Results Of 6,285 trial- and LCS-eligible individuals, 3,897 (62%) declined and 2,388 (38%) enrolled. In multivariable logistic regression analyses, Blacks had higher enrollment rates (OR 1.5, 95% CI 1.2,1.8) compared to Whites. Compared to ‘NRT Only’ trials, those approached for ‘NRT+prescription medication’ trials had higher odds of enrollment (OR 6.1, 95% CI 4.7,7.9). Regarding enrollment methods, trials using ‘Phone+In Person’ methods had higher odds of enrollment (OR 1.6, 95% CI 1.2,1.9) compared to trials using ‘Phone Only’ methods. Some of the reasons for declining enrollment included ‘too busy’ (36.6%), ‘not ready to quit’ (8.2%), ‘not interested in research’ (7.7%), and ‘not interested in the intervention offered’ (6.2%). Conclusion Enrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers. Implications We explored enrollment rates and reasons for declining across six smoking cessation trials in the lung cancer screening setting. Offering multiple accrual methods and pharmacotherapy options predicted increased enrollment across trials. Enrollment rates were also greater among Blacks compared to Whites. The findings offer practical information for the implementation of cessation trials and interventions in the lung cancer screening context and other clinical settings, regarding intervention modalities that may be most appealing to older, long-term smokers.

Two decades of ITALUNG. What we have learned and what is yet to be addressed in lung cancer screening with low dose CT.

“…To date, some of these studies have provided evidence for the integration of cessation in the lung screening context. Offering multiple accrual methods and at multiple points over the screening may help to engage the smokers, and providing pharmacotherapy options promotes enrolment [118]. Retention and treatment engagement differ on demographic, clinical, and psychological characteristics (e.g., number of cigarettes smoked per day, education, worry about lung cancer, screening results) [119].…”

Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed

“…To date, some of these studies have provided evidence for the integration of SCP in the lung screening context. Offering multiple accrual methods and at multiple points during the screening regimen may help to engage current smokers, and, by providing pharmacotherapy options, to promote enrolment [ 121 ]. As expected, treatment engagement and retention reflect demographic, clinical, and psychological characteristics (e.g., number of cigarettes smoked per day, education, worry about LC, and screening results) [ 122 ].…”

Engaging Patients in Smoking Cessation Treatment within the Lung Cancer Screening Setting: Lessons Learned from an NCI SCALE Trial

“…To determine how best to integrate smoking cessation treatment in the lung screening setting, the National Cancer Institute initiated the Smoking Cessation at Lung Examination (SCALE) collaboration [7] that is comprised of eight clinical trials, including Georgetown's Lung Screening, Tobacco, and Health (LSTH) trial (NCT03200236) [8][9][10][11][12]. To date, several SCALE-related papers have assessed predictors of enrollment and retention [7,10,13].…”

“…To determine how best to integrate smoking cessation treatment in the lung screening setting, the National Cancer Institute initiated the Smoking Cessation at Lung Examination (SCALE) collaboration [7] that is comprised of eight clinical trials, including Georgetown's Lung Screening, Tobacco, and Health (LSTH) trial (NCT03200236) [8][9][10][11][12]. To date, several SCALE-related papers have assessed predictors of enrollment and retention [7,10,13]. In a cross-project analysis of enrollment across six of the eight SCALE trials (n = 6285), we found that participants were more likely to be Black or African American, were less likely to be of Hispanic ethnicity, and were significantly younger compared to their counterparts among those who declined enrollment or could not be reached [7].…”

“…To date, several SCALE-related papers have assessed predictors of enrollment and retention [7,10,13]. In a cross-project analysis of enrollment across six of the eight SCALE trials (n = 6285), we found that participants were more likely to be Black or African American, were less likely to be of Hispanic ethnicity, and were significantly younger compared to their counterparts among those who declined enrollment or could not be reached [7]. The offer of multimodal counseling along with nicotine replacement therapy (NRT) plus prescription medication were strong predictors of enrollment compared to trials offering phone-only counseling or NRT alone.…”