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Telephone-based intervention after lung cancer screening quadruples smoking cessation rates
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A telephone-based counseling intervention following lung cancer screening increased cessation rates among current smokers, according to study results published in Lung Cancer.
Kathryn L. Taylor, PhD, a behavioral scientist and professor of oncology at Georgetown Lombardi Comprehensive Cancer Center, and colleagues conducted a randomized pilot study that included 92 current smokers who underwent lung cancer screening. Half of them received six brief telephone counseling sessions after screening. The other half received a standard protocol that included a list of free and low-cost smoking cessation resources.
Study groups were balanced with regard to percentages of patients with normal and abnormal screening results, and no study participants had lung cancer.
Researchers used a nicotine saliva test to confirm whether patients had stopped smoking.
More than four times as many study participants who received the telephone-based intervention stopped smoking at 3-month follow-up.
“Millions of current smokers are now eligible for lung cancer screening, so this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related diseases,” Taylor said in a press release. “This is a great way to engage smokers who have not sought out cessation help.”
HemOnc Today spoke with Taylor about the study results and their potential implications.
Question: What makes this study unique?
Answer: To our knowledge, there have been only four other randomized studies in the lung cancer screening setting for smoking cessation. Two studies used telephone counseling but with different protocols. Although these studies did show promising results, none were able to show significant differences between the telephone counseling and control arms.
Q: Why did you choose a telephone-based intervention?
A: Telephone-based counseling for smoking cessation is an evidence-based method that has been shown to be very effective for many populations in randomized trials. This includes the older adult population, which is the group eligible for screening, and those who are not ready to quit. We chose telephone-based counseling because a good portion of smokers who are screened for lung cancer are only interested in screening. They are not thinking about quitting at the time of screening. Additionally, we wanted to use a strategy that did not require people to come back to the screening site for in-person sessions, as we did not think it would reach as many people. It also allowed us to individualize the session and tailor it to those who might be ready to set a quit date immediately vs. those who are not ready to quit. It allows a lot of leeway in terms of how the counseling can be structured.
Q: Can you summarize the results?
A: Providing this telephone-based cessation counseling was more effective for helping people to stop smoking than what is considered usual care in many areas of lung screening. That approach entails providing a list of free and low-cost interventions that participants are required to access themselves. The usual care arm in our preliminary study consisted of giving participants the phone number for the National Quit Line (1-800-QUIT-NOW), handing them a booklet about cessation designed for patients considering quitting smoking, providing a link to a website produced by the Truth Initiative, and encouraging them to access local cessation resources. We provided the same information to participants in the intervention arm, in addition to the opportunity to engage in six 15- to 20-minute telephone counseling sessions. Our data showed a 17% quit rate among those who received telephone-based counseling, and a 4% quit rate among those who received usual care.
Q: Did the findings surprise you?
A: We were excited about our findings. When we set out to do this, we attempted to recruit all current smokers — both those who said they were ready to quit and those who said they were not thinking about quitting. In this sample of 92 participants, half told us they were not ready to quit. We told them that was fine, and that we just wanted to talk to them. Some of these participants ended up quitting. The goal is to get people to think about quitting and think about strategies and methods to quit that they may not have used in the past. Even if they choose to not use these strategies right away, they at least have an understanding of what is out there in terms of evidence-based methods for when they are ready to quit. It is a teachable moment. We capture people who are at least willing to talk about quitting.
Q: How might other institutions implement this type of intervention?
A: It is not a simple matter to provide telephone counseling, but it is easy to provide evidence-based resources to patients. We conducted the telephone counseling from Georgetown so we could provide a protocol that included a focus on the lung cancer screening as a motivator to consider quitting. I recommend that lung cancer screening sites without an in-house cessation program provide the 1-800-QUIT-NOW line to their patients. It also is possible to do a fax referral, which means that quit line staff can call the screening participants. It also is important to note that 4% of participants in our standard-care group quit, so providing cessation materials to also may be important.
Q: What are the next steps in your research?
A: We received funding from the NCI to conduct a larger trial. The NCI is very interested in figuring out how to provide effective cessation interventions to people who are undergoing lung cancer screening. We will compare two forms of telephone-based counseling interventions among nearly 1,300 people accrued from five sites around the country, three of which were included in our pilot study. Our pilot study only followed people for 3 months. In this larger study, we will follow participants for 1 year.
Q: Is there anything else that you would like to mention?
A: It is important to always be mindful of the five As — Asking, Advising, Assessing, Assisting and Arranging — for current smokers in your practice. We need to provide support, continue to talk with them about quitting, offer appropriate medications, encourage them to seek other resources and continue to discuss the negative impact that smoking can have on their health. These are all important discussions to have, even when our patients are saying that they are not ready to quit. – by Jennifer Southall
Reference:
Taylor KL, et al. Lung Cancer. 2017;doi:10.1016/j.lungcan.2017.01.020.
For more information:
Kathryn L. Taylor, PhD, can be reached at Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven St. NW, Suite 4100, Washington, DC 20007;email: taylorkl@georgetown.edu.
Disclosure: Taylor reports no relevant financial disclosures.