Adding prescription medication to tobacco longitudinal care does not improve abstinence

Key takeaways:

• Smoking abstinence did not differ based on the availability of prescription medicines combined with tobacco longitudinal care.
• Individuals contacted monthly vs. quarterly had higher long-term abstinence rates.

Prescription medications added onto tobacco longitudinal care did not improve long-term abstinence rates among current smokers eligible for lung cancer screening, according to results published in JAMA Network Open.

“If we do not help people quit smoking, we will not adequately reap the benefits of lung cancer screening,” Steven S. Fu, MD, MSCE, professor at University of Minnesota Medical School, said in a press release from University of Minnesota. “The [Program for Lung Cancer Screening and Tobacco Cessation] trial shows that we can deliver both intensive behavioral treatment and medications to help people quit by integrating a longitudinal tobacco cessation care program into the lung cancer screening setting.”

In a sequential, multiple assignment, randomized clinical trial, Fu and colleagues analyzed 636 (median age, 64.3 years; 35.9% women; 89.4% white) current daily cigarette smokers eligible for lung cancer screening to see if long-term smoking abstinence among those who did not have an early response to tobacco treatment improved with vs. without a referral to prescription medication therapy in addition to tobacco longitudinal care.

Individuals participated in tobacco longitudinal care for 1 year, and this program consisted of intensive telephone coaching plus combination nicotine replacement therapy, according to researchers.

Researchers additionally sought to evaluate the influence of quarterly vs. monthly contact in tobacco longitudinal care among individuals who quit smoking shortly after starting the treatment.

Of the total cohort, 126 individuals (19.8%) quit smoking 4 or 8 weeks after starting treatment, signaling an early treatment response, whereas 510 individuals (80.2%) continued smoking.

Notably, 529 individuals (113 early treatment responders; 416 early treatment nonresponders) completed the 18-month follow-up survey, which included data on abstinence rates 6 months after completing the 1-year treatment program. Results demonstrated that 129 individuals (24.4%) achieved 6-month prolonged abstinence.

Of the early treatment nonresponders, half (n = 208) received tobacco longitudinal care with medication therapy management, whereas the other half (n = 208) only received tobacco longitudinal care. Prolonged abstinence rates between these subgroups did not significantly differ (tobacco longitudinal care plus medication therapy management, 17.8% vs. tobacco longitudinal care, 16.4%), according to researchers.

Among the early treatment responders receiving tobacco longitudinal care, 55 individuals were contacted quarterly and 58 were contacted monthly. Compared with those receiving monthly contact, researchers found that those being contacted quarterly had a lower 6-month prolonged abstinence rate (58.6% vs. 43.6%); however, this difference was not statistically significant.

Further, Fu and colleagues wrote that biochemical verification of participants’ self-reported abstinence is limited and should be considered when interpreting these results.

“Long-term smoking abstinence rates for longitudinal care are higher than abstinence rates observed in shorter interventions and indicate the value of taking a longitudinal or chronic care approach to tobacco cessation,” Fu and colleagues wrote. “Findings also show that patients undergoing [lung cancer screening] who smoke accept [tobacco longitudinal care], as evidenced by their completion of a relatively large number of calls over a year-long period. Health systems should consider integrating longitudinal tobacco cessation care into the [lung cancer screening] setting.”

Reference:

• Optimizing tobacco cessation treatment with lung cancer screening. https://reporterpass.umn.edu/release/optimizing-tobacco-cessation-treatment-lung-cancer-screening. Published Aug. 24, 2023. Accessed Aug. 28, 2023.