Uptake of smoking cessation support high when offered at lung cancer screening
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Key takeaways:
- Factors related to smoking (nicotine dependency, self-efficacy for quitting) impacted uptake of cessation support.
- At a 4-week follow-up, 323 of 2,150 (15%) current smokers said they quit.
An offer to speak with a smoking cessation practitioner during a lung cancer screening appointment was accepted by a majority of current smokers, according to results published in European Respiratory Journal.
“These results show the importance of having properly funded stop smoking support available to those people who smoke and attend for lung screening,” Rachael L. Murray, PhD, professor of population health at University of Nottingham, told Healio. “The potential to reduce health inequalities and reduce smoking related morbidity and mortality in this high-risk population is an opportunity not to be missed.”
Using data from the Yorkshire Lung Screening Trial, Murray and colleagues assessed 2,150 adults (mean age, 65.5 years; 50.4% men; 95.3% white) that currently smoked and underwent low-dose CT lung cancer screening to evaluate uptake of immediate consultation with a smoking cessation practitioner when offered at screening, ongoing cessation support and 4-week quit rates.
Researchers reported that the consultation offer was accepted by 1,905 (89%) adults, and as weeks passed, 75% (n = 1,609) of this population had continued use of smoking cessation support.
To determine if any demographic characteristics (age, sex, ethnicity, deprivation, educational level) were linked to uptake of continued support, researchers used multivariable analysis.
Apart from sex, there was no link between the above demographics and uptake of continued smoking cessation support. Between men and women, men had lower odds for uptake (adjusted OR = 0.71; 95% CI, 0.56-0.89; P = .002).
Notably, several factors related to smoking increased uptake of cessation support:
- high nicotine dependency (vs. low dependency, aOR = 2.25; 95% CI, 1.51-3.33);
- moderate nicotine dependency (vs. low dependency, aOR = 1.43; 95% CI, 1.12-1.83);
- highest motivation to stop smoking (vs. lowest motivation, aOR = 6.36; 95% CI, 3.9-10.39);
- slightly/somewhat self-efficacy for quitting (vs. no self-efficacy, aOR = 1.55; 95% CI, 1.13-2.12); and
- moderately/extremely self-efficacy for quitting (vs. no self-efficacy, aOR = 1.43; 95% CI, 1.06-1.95).
At the 4-week mark, researchers asked all 2,150 adults about smoking status, and 323 reported quitting. Of the 323 adults, 322 had been receiving ongoing smoking cessation support.
Further, researchers validated quitting in 266 adults via exhaled carbon monoxide.
“The study findings were really promising, showing that the offer of stop smoking support was taken up by all demographic groups,” Murray said. “Early quit rates also show positive impact of the offer.”
Although men had lower odds for uptake of smoking cessation support, they had higher odds for quitting at 4 weeks vs. women (aOR = 1.43; 95% CI, 1.11-1.84; P = .005).
A high vs. low motivation to quit (aOR = 4.05; 95% CI, 2.71-6.05; P < .001) and one prior attempt at quitting vs. none (aOR = 2; 95% CI, 1.45-2.75; P < .001) also raised the odds for 4-week quitting, according to researchers.
Researchers found decreased odds for quitting at 4 weeks among individuals who smoked 11 to 20 cigarettes daily vs. less than 10 cigarettes a day (aOR = 0.61; 95% CI, 0.46-0.8).
“Future research should build on the results reported in the current study; investigating the effectiveness, cost-effectiveness and feasibility of integrating stop smoking support within lung screening,” Murray said.
Reference:
- Smoking-related deaths could be reduced if people attending lung cancer screening are offered stop-smoking support. https://www.nottingham.ac.uk/news/smoking-related-deaths-could-be-reduced-if-people-attending-lung-cancer-screening-are-offered-stop-smoking-support. Published April 18, 2024. Accessed April 22, 2024.
Perspective
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This pioneering study shines light on a promising method to integrate smoking cessation strategies within the framework of a lung cancer screening program. Prolonged smoking abstinence reduces lung cancer-related mortality alone and when combined with lung cancer screening the reduction in mortality is compounded.
Although current guidelines recommend that smoking cessation should be offered to lung cancer screening participants, there is limited evidence on how to effectively integrate smoking cessation treatment into screening, and cessation rates remain low. This group effectively employed an opt-out approach to smoking cessation counseling within the context of a community-based lung cancer screening program.
Participants demonstrated surprisingly high engagement in smoking cessation counseling not only in the initial visit, but also in ongoing smoking cessation treatment. To see this level of engagement, especially within this high risk, underserved population with lower levels of education, was remarkable. It was also unexpected that participants with higher levels of nicotine dependency were more likely to engage with smoking cessation support, suggesting a level of self-awareness and motivation among a group previously thought to be recalcitrant toward cessation efforts.
Interestingly, although women were more likely to engage in smoking cessation support, men were more likely to be successful in cessation. Furthermore, the majority of individuals receiving ongoing support accepted pharmacologic therapy, although the practice of prescribing e-cigarettes for cessation remains controversial. The findings that individuals with higher motivation to quit or who had previous quit attempts were more successful in quitting are consistent with what is seen in clinical practice.
Although their cessation rates were slightly higher compared with other similar studies, still only 15% quit. Additionally, cessation was defined as abstinence from tobacco for the last 7 days, which may not be sustained for longer periods after a 4-week follow-up, especially since most people who smoke require multiple quit attempts to successfully quit long term. However, having a previous quit attempt does predict higher likelihood of quitting successfully in the future.
This example of successful engagement of lung cancer screening participants in smoking cessation support using an opt-out process may well reframe the structure of lung cancer screening programs and provider practice. This approach should maintain patient faculty and autonomy in a nonjudgemental and supportive way. Synchronizing smoking cessation support with lung cancer screening may be more compelling and convenient for patients overall. Further research is needed on how to successfully implement smoking cessation treatment to increase overall cessation rates long term, but this evidence of engagement is promising.
References:
Chaiton M, et al. BMJ Open. 2016;doi:10.1136/bmjopen-2016-011045.
Moldovanu D, et al. Transl Lung Cancer Res. 2021;doi:10.21037/tlcr-20-899.
Tanner NT, et al. Am J Respir Crit Care Med. 2016;doi:10.1164/rccm.201507-1420OC.
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