Smoking Cessation by Phone Counselling in a Lung Cancer Screening Program: A Retrospective Comparative Cohort Study

Abstract

Introduction. Smoking cessation integration within lung cancer screening programs is challenging. Currently, phone counselling is available across Canada for individuals referred by healthcare workers and by self-referral. We compared quit rates after phone counselling interventions between participants who self-refer, those referred by healthcare workers, and those referred by a lung cancer screening program. Methods. This is a retrospective cohort study of participants referred to provincial smoking cessation quit line in contemporaneous cohorts: self-referred participants, healthcare worker referred, and those referred by a lung cancer screening program if they were still actively smoking at the time of first contact. Baseline, covariates (sociodemographic information, smoking history, and history of mental health disorder) and quit intentions (stage of change, readiness for change, previous use of quit programs, and previous quit attempts) were compared among the three cohorts. Our primary outcome was defined as self-reported 30-day abstinence rates at 6 months. Multivariable logistic regression was used to identify whether group assignment was associated with higher quit rates. Results. Participants referred by a lung cancer screening program had low quit rates (12%, 95% CI: 5–19) at six months despite the use of phone counselling. Compared to patients who were self-referred to the smoking cessation phone helpline, individuals referred by a lung cancer screening program were much less likely to quit (adjusted OR 0.37; 95% CI: 0.17–0.8), whereas those referred by healthcare workers were twice as likely to quit (adjusted OR 2.16 (1.3–3.58)) even after adjustment for differences in smoking intensity and quit intentions. Conclusions. Phone counselling alone has very limited benefit in a lung cancer screening program. Participants differ significantly from those who are otherwise referred by healthcare workers. This study underlines the importance of a dedicated and personalized tobacco treatment program within every lung cancer screening program. The program should incorporate best practices and encourage treatment regardless of readiness to quit.

Lung cancer smokers: quit smoking is a component of treatment

“…Le terapie cognitive e comportamentali vengono condotte in ogni fase del follow-up, aumentano l'efficacia delle medicazioni, rafforzano il senso di autoefficacia del paziente, la compliance terapeutica e consentono un migliore controllo del desiderio (craving) [3,5,[25][26][27]. Il supporto a distanza (consulenza telefonica) rafforza l'astinenza dei pazienti, così come la casa senza fumo [3,5,25,26,28,29].…”

“…Cognitive and behavioral therapies (CBT)Cognitive and behavioral therapies (CBT) are conducted at each step of follow-up, increase the efficacy of médications, reinforce the patient's sense of self-efficacy, therapeutic compliance, enable better control of craving[3,5,[25][26][27]. Long-distance support (telephone counselling) reinforce patients abstinence, as well as smokefree home[3,5,25,26,28,29].…”

Tobacco treatment in the setting of lung cancer screening

“…Taylor et al demonstrated phone counseling and NRT provided with LCS is an effective strategy to increase short-term quit rates [27]. However, a separate study evaluating quit rates by telephone counseling of participants referred from an LCS program found low quit rates compared with self-referred patients, suggesting a multimodal or personalized approach should be considered [28]. Moreover, NLST findings also were notable for the lowest quit rate in patients with a low risk or ‘normal scan’, suggesting wrong lesson could be taken away from the teachable moment of LCS [25].…”

Smoking Cessation Management for Lung Cancer Smokers: An Essential Component of Treatment

“…3,5,22 Long-distance support (telephone counselling) help patients to maintain abstinence and a smoke-free home. 5,22,23 The combination of short-acting nicotine replacement therapy (NRT) (gum, lozenge, spray) and long-acting NRT (patch) with a duration of 12 to 24 weeks, increases the odds of success nearly 3-fold compared with placebo (OR= 2.73; CI 95%: 2.07-3.65). No carcinogenic effects of NRT have been reported.…”