Immediate, Remote Smoking Cessation Intervention in Participants Undergoing a Targeted Lung Health Check

Abstract

BackgroundLung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective.Research QuestionDoes an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)?Study Design and MethodsIn a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression.ResultsThree hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention.InterpretationImmediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months.Trial RegistryISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression. Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. Immediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. ISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com Take-home PointsStudy Question: Does an immediate telephone smoking cessation intervention (TSI) increase quit rates compared with usual care (UC) among a population enrolled in a targeted lung health check?Results: Self-reported quit rates were higher in the intervention arm compared with the UC arm: TSI, 21.1% vs UC, 8.9%.Interpretation: Immediate provision of an intensive TSI, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. Study Question: Does an immediate telephone smoking cessation intervention (TSI) increase quit rates compared with usual care (UC) among a population enrolled in a targeted lung health check? Results: Self-reported quit rates were higher in the intervention arm compared with the UC arm: TSI, 21.1% vs UC, 8.9%. Interpretation: Immediate provision of an intensive TSI, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. Targeted screening programs using low-dose CT (LDCT) imaging have been proposed as a solution to reduce the impact of lung cancer by diagnosing it at an earlier, potentially curable, stage. Large randomized controlled trials have demonstrated that this approach can reduce mortality resulting from lung cancer by between 20% and 60%,1Aberle D.R. Adams A.M. et al.National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7640) Google Scholar,2de Koning H.J. van der Aalst C.M. de Jong P.A. et al.Reduced lung-cancer mortality with volume CT screening in a randomized trial.N Engl J Med. 2020; 382: 503-513Crossref PubMed Scopus (1569) Google Scholar and LDCT scan screening is now recommended by the United States Preventative Services Taskforce.3United States Preventative Services TaskforceLung cancer: screening 2021. United States Preventative Services Taskforce website.https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screeningGoogle Scholar In 2019, the National Health Service (NHS) England launched targeted lung health check (TLHC) pilot projects at various sites across the United Kingdom to investigate the feasibility and effectiveness of LDCT scan screening within the United Kingdom.4NHS EnglandNews NHS to rollout lung cancer scanning trucks across the country 2019. National Health Service website.https://www.england.nhs.uk/2019/02/lung-trucks/Google Scholar More recently, the National Screening Committee began a public consultation regarding a national rollout of TLHC across the United Kingdom.5United Kingdom National Screening CommitteeAdult screening programme. Lung cancer 2022. United Kingdom National Screening Committee website.https://view-health-screening-recommendations.service.gov.uk/lung-cancer/Google Scholar Tobacco smoking is among the largest causes of morbidity and mortality, and thus, smoking cessation is a key aspect of the prevention and treatment both of respiratory disease and many conditions occurring beyond the lungs.6World Health OrganizationTobacco 2021. World Health Organization website.https://www.who.int/news-room/fact-sheets/detail/tobaccoGoogle Scholar Lung cancer screening eligibility criteria targets high-risk individuals who smoke, who differ in certain ways from the general smoking population, being older, often with multiple comorbidities and a longer smoking history, and having greater tobacco dependence.1Aberle D.R. Adams A.M. et al.National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7640) Google Scholar,7Kathuria H. Detterbeck F.C. Fathi J.T. et al.Stakeholder research priorities for smoking cessation interventions within lung cancer screening programs. An official American Thoracic Society research statement.Am J Respir Crit Care Med. 2017; 196: 1202-1212Crossref PubMed Scopus (25) Google Scholar LDCT scan screening trials have demonstrated higher quit rates in intervention than control arms, and thus, the screening process can be considered to be a so-called teachable moment for smoking cessation.8Brain K. Carter B. Lifford K.J. et al.Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial.Thorax. 2017; 72: 912-918Crossref PubMed Scopus (86) Google Scholar,9Ashraf H. Tønnesen P. Pedersen J.H. Dirksen A. Thorsen H. Døssing M. Effect of CT screening on smoking habits at 1-year follow-up in the Danish Lung Cancer Screening Trial (DLCST).Thorax. 2009; 64: 388-392Crossref PubMed Scopus (130) Google Scholar Making the best use of this is crucial, and the provision of evidence-based smoking cessation within screening programs has been advocated.10Joseph A.M. Rothman A.J. Almirall D. et al.Lung cancer screening and smoking cessation clinical trials. SCALE (Smoking Cessation Within the Context of Lung Cancer Screening) collaboration.Am J Respir Crit Care Med. 2018; 197: 172-182Crossref PubMed Scopus (93) Google Scholar The effectiveness of different approaches remains a key question for research to establish which specific approaches should be used to maximize the value and impact of the lung health check.11Clark M.M. Cox L.S. Jett J.R. et al.Effectiveness of smoking cessation self-help materials in a lung cancer screening population.Lung Cancer. 2004; 44: 13-21Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 12Taylor K.L. Hagerman C.J. Luta G. et al.Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: a randomized clinical trial.Lung Cancer. 2017; 108: 242-246Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 13Tremblay A. Taghizadeh N. Huang J. et al.A randomized controlled study of integrated smoking cessation in a lung cancer screening program.J Thorac Oncol. 2019; 14: 1528-1537Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 14Marshall H.M. Courtney D.A. Passmore L.H. et al.Brief tailored smoking cessation counseling in a lung cancer screening population is feasible: a pilot randomized controlled trial.Nicotine Tob Res. 2016; 18: 1665-1669Crossref PubMed Scopus (32) Google Scholar In the Quit Smoking Lung Intervention Trial (QuLIT) initial phase (QuLIT 1), we demonstrated a significant increase in 3-month quit rate (29.9% vs 11%) for TLHC participants randomized to receive immediate face-to-face cessation support and pharmacotherapy compared with usual care (UC). The latter consisted of very brief advice (VBA) to quit and signposting to smoking cessation support.15Buttery S.C. Williams P. Mweseli R. et al.Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial.BMJ Open Respir Res. 2022; 9: e001030Crossref PubMed Scopus (11) Google Scholar Because of the COVID-19 pandemic, face-to-face support was suspended in March 2020 and the study was modified to investigate, in a discrete second phase (QuLIT 2), whether remote delivery of the smoking cessation intervention also was effective compared with UC. QuLIT 2 was a single-masked, randomized controlled trial comparing the effectiveness of an immediate, intensive telephone smoking cessation intervention (TSI) compared with VBA to quit and signposting delivered in the context of a in the of and and who were 55 to 75 years of age with a of smoking were for a TLHC as S.C. Williams P. Mweseli R. et al.Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial.BMJ Open Respir Res. 2022; 9: e001030Crossref PubMed Scopus (11) Google Scholar current smokers who part in the TLHC were in the study smokers were as smoking including and at the of the participants who were in the study population, of or to The Lung is an lung cancer screening pilot delivered by the by the Cancer and the NHS the National Cancer Because of the COVID-19 pandemic, in initial TLHC were to a remote telephone delivery an of current or smoking and history, and cancer participants were at of lung cancer to the and Trial or Lung screening A. van M. et an model for lung J Cancer. PubMed Scopus Google K. J. et for of lung cancer screening a Med. 2017; Scopus Google Scholar were for an LDCT The study was by the Research Committee and the Health Research The for was by the this have been an intervention and have in the control The initial QuLIT and the study reported QuLIT were in the trial attended the TLHC between and 2021. of the that were allocated by as TSI and as UC for the TLHC were allocated by an who was of to which study arm the been in the TSI a telephone from the smoking cessation the initial TLHC on this so-called teachable the smoking cessation to the participants on the day that the were to the the were of telephone counselling support in to pharmacotherapy or were on the National for Smoking Cessation and and for Smoking Cessation and 2021. 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National for Smoking Cessation and Scholar which intervention was The of by the participants was with of participants the The of for the telephone was follow-up were for of participants UC participants TSI participants Quit rates were higher in the intervention arm: 21.1% vs 8.9% (OR, 2.83; 95% CI, P = The quit including and also was higher in the TSI participants vs participants 95% CI, P = whether undergoing the CT scan quit rates among the study Within the UC arm, undergoing a CT scan not quit UC CT participants vs UC with CT participants 95% CI, P = was within the TSI study arm: among TSI participants who not a CT of participants quit compared with of participants among TSI participants who a CT scan (OR, 95% CI, P = Cessation and Quit at 3 (n = (n = smoking a quit both and quit used to support quit as = TSI = telephone smoking cessation UC = usual both and quit Open in a as = TSI = telephone smoking cessation UC = usual The use of of and quit was in the TSI (OR, 95% CI, P participants in the UC were to use of to quit vs UC, in the UC arm of participants to quit support quit and of participants used the NHS smoking from the two logistic in from participants who not a CT scan were from model CT scan or and smoking characteristics of age and of years effect on quit rates at 3 within the of Smoking at 3 and CT (n = and Smoking (n = vs scan or follow-up or of of years as P or follow-up or Open in a as P The of this randomized controlled trial is that the provision of smoking cessation support including counselling support and pharmacotherapy, delivered by telephone immediately attendance at a increased 7-day point prevalence smoking abstinence at 3 compared with UC of VBA to quit and signposting to smoking cessation support the that the immediate provision of intensive smoking cessation support for high-risk people who smoke undergoing TLHC is effective vs for quit rates within this than UC. from QuLIT which that immediate face-to-face support can increase quit rates compared with UC vs 11%) in the context of S.C. Williams P. Mweseli R. et al.Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial.BMJ Open Respir Res. 2022; 9: e001030Crossref PubMed Scopus (11) Google Scholar the two the quit rates in the UC groups in both were quit rates in the face-to-face intervention were The of quit also was higher in the intervention vs UC, and between both the QuLIT and 2 interventions (QuLIT the two approaches were not compared be to which approach is effective. including the initial QuLIT have the impact of smoking cessation support within lung cancer screening with by including and the and of M.M. Cox L.S. Jett J.R. et al.Effectiveness of smoking cessation self-help materials in a lung cancer screening population.Lung Cancer. 2004; 44: 13-21Abstract Full Text Full Text PDF PubMed Scopus (87) Google K.L. Hagerman C.J. Luta G. et al.Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: a randomized clinical trial.Lung Cancer. 2017; 108: 242-246Abstract Full Text Full Text PDF PubMed Scopus (37) Google H.M. Courtney D.A. Passmore L.H. et al.Brief tailored smoking cessation counseling in a lung cancer screening population is feasible: a pilot randomized controlled trial.Nicotine Tob Res. 2016; 18: 1665-1669Crossref PubMed Scopus (32) Google S.C. Williams P. Mweseli R. et al.Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial.BMJ Open Respir Res. 2022; 9: e001030Crossref PubMed Scopus (11) Google P.A. P. et al.A intervention for smokers in lung cancer a pilot feasibility 2018; Scopus Google Scholar The 3-month quit rate of 21.1% in the QuLIT 2 intervention arm is with that of in which quit rates from to the two that reported quit rates than current study cessation and and not M.M. Cox L.S. Jett J.R. et al.Effectiveness of smoking cessation self-help materials in a lung cancer screening population.Lung Cancer. 2004; 44: 13-21Abstract Full Text Full Text PDF PubMed Scopus (87) Google P.A. P. et al.A intervention for smokers in lung cancer a pilot feasibility 2018; Scopus Google Scholar also have which be associated with smoking cessation within TLHC et A. Taghizadeh N. Huang J. et al.A randomized controlled study of integrated smoking cessation in a lung cancer screening program.J Thorac Oncol. 2019; 14: 1528-1537Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar that who reported a of at and or were to be smoking at A. Taghizadeh N. Huang J. et al.A randomized controlled study of integrated smoking cessation in a lung cancer screening program.J Thorac Oncol. 2019; 14: 1528-1537Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar In the screening trial, individuals who smoke with higher and higher to quit were to have quit at the der Aalst C.M. de Koning H.J. van van The effectiveness of a smoking cessation intervention for participants in lung cancer a controlled trial.Lung Cancer. Full Text Full Text PDF PubMed Scopus Google Scholar we between participant characteristics and smoking this be the of a of The effect of undergoing a CT scan vs not undergoing a CT scan as part of a TLHC not quit rates within this population vs support the of smoking cessation support to taking part in not that for low-dose CT cessation were by people to quit in both study participants in the TSI were to use including and is the of and support were the of the intervention. the pharmacotherapy use within the UC arm was 6 of participants who to quit used pharmacotherapy and participants in the UC arm cessation support from advice and signposting to use to support quit was higher in the UC arm of the study vs UC, that in the of support and pharmacotherapy, individuals who smoke to this to support the effectiveness of in the context of lung cancer with higher 3-month abstinence with both and compared with a control M. K. et support smokers with to smoking in the by randomized controlled trial.Nicotine Tob Res. 2019; PubMed Scopus Google Scholar with the from the and that it support the of for smoking and for and as 2021. United Kingdom Scholar that of cessation interventions within a screening context in the United Kingdom should be to support people using this of have the to delivery of TLHC programs of smoking cessation support delivery in this QuLIT and 2 quit rates with intervention either to or compared with UC. face-to-face approaches be effective for to in delivered interventions in for people in remote and and of the COVID-19 pandemic, have been on face-to-face also that pharmacotherapy within the smoking cessation support is an of the to is that a of delivery and pharmacotherapy be most appropriate for a population with and the multiple and that lung screening smoking cessation study of lung cancer screening in the United States reported that not have to to smoking cessation care and on lung cancer Thorac 2016; PubMed Scopus Google Scholar and to use specific smoking cessation to within screening be provide tailored and telephone including both counselling and pharmacotherapy of which from clinical in to the of the screening and intervention in clinical health impact and J Med. Full Text Full Text PDF PubMed Scopus Google Scholar the study in the context of a clinical lung cancer from the or in from the provision of the smoking cessation support on TSI which the of the The of current smokers enrolled in the Lung of current or to quit, to the impact of the approach within the population, not immediately to and should be we used self-reported 7-day point smoking prevalence as the primary than quit rates, to study and participant point prevalence self-reported a known abstinence within clinical et and abstinence in clinical trials of smoking cessation an Tob Res. 2020; PubMed Scopus Google Scholar often used in cessation screening trials as an outcome K. Carter B. Lifford K.J. et al.Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial.Thorax. 2017; 72: 912-918Crossref PubMed Scopus (86) Google K.L. Hagerman C.J. Luta G. et al.Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: a randomized clinical trial.Lung Cancer. 2017; 108: 242-246Abstract Full Text Full Text PDF PubMed Scopus (37) Google A. Taghizadeh N. Huang J. et al.A randomized controlled study of integrated smoking cessation in a lung cancer screening program.J Thorac Oncol. 2019; 14: 1528-1537Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar The use of increase the of the study the of the population is which is higher than the of people as in and of and Scholar of in the of Scholar and of of Scholar is the to follow-up within the population was higher than it was to that in M.M. Cox L.S. Jett J.R. et al.Effectiveness of smoking cessation self-help materials in a lung cancer screening population.Lung Cancer. 2004; 44: 13-21Abstract Full Text Full Text PDF PubMed Scopus (87) Google M. K. et support smokers with to smoking in the by randomized controlled trial.Nicotine Tob Res. 2019; PubMed Scopus Google Scholar taking the that to follow-up to smoke, not the study intensive telephone-based smoking cessation support with pharmacotherapy, delivered within a TLHC increased the 3-month quit that this approach is appropriate and effective for this population and that to smoking cessation support should be within the delivery of lung cancer was by Cancer by The NHS

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