MA 18.02 Outcomes of Integrating Smoking Cessation Counseling in a Lung Screening Program

7525 Background: The National Lung Screening Trial (NLST) demonstrated a 20% relative reduction in lung cancer mortality for current and former heavy smokers screened with low-dose CT vs. radiography. The NCCN and ACS recently released lung screening guidelines which promote smoking cessation counseling, but there is no information about the prevalence or effectiveness of brief physician-delivered smoking cessation interventions, such as the 5As (Ask, Advise, Assess, Assist, and Arrange follow-up) among lung screening patients. Methods: Among 8,878 NLST participants from 23 ACRIN sites who were smoking at enrollment, we conducted a longitudinal examination of the 1) rates and patterns of each reported 5A receipt and 2) association between each A and quitting. Using a case-control logistic regression, which matched participants according to trial arm; sociodemographic; medical; and smoking characteristics, we compared self-reported point-prevalence abstinence following 5A receipt. Results: Participants were 54% male, 90.6% white, and mean age 60.8 years. Receipt of 5As was consistent for the first 3 study years; rates of Ask (75%) and Advise (74%), exceeded rates of Assess (64%), Assist (58%), and Arrange follow-up (13%). Receipt of Ask, Advise, and Assess did not significantly increase the odds of a participant quitting smoking. Assist (cessation counseling, medication) increased the odds of quitting smoking by 22% (p=0.0002), and Arrange follow-up increased the odds of quitting by 20% (p=0.002). Older age and lower nicotine dependence were significantly associated with quitting, after accounting for the effectiveness of Assist (OR=1.34, CI: 1.16-1.55; OR== 0.95, CI: .93-.97) and Arrange follow-up (OR=1.34, CI: 1.16, 1.54; OR=.95, CI: .93-.97). Conclusions: Among high risk patients undergoing lung screening, Advice to quit was not associated with improved odds of smokers’ quitting. Assist and Arrange follow-up were associated with improved odds of smokers’ quitting, but unfortunately, rates of receipt of these As were low. Physician-delivered smoking cessation assistance and follow-up has the potential to enhance the effectiveness and cost effectiveness of lung screening. Clinical trial information: CDR0000257938.

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Implementation of a low-dose computerized tomography (LDCT) lung cancer screening program (LCSP) across a large integrated health system.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1537 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1537-1537

Author(s):

Marija Bjegovich-Weidman ◽

Steven Leh ◽

Daniel Malone ◽

Raul Mendoza-Ayala ◽

Anne Marie Barry-Weers ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Early Detection ◽

Incidental Findings ◽

Screening Program ◽

Cancer Case ◽

Smoking Cessation Counseling ◽

Detection Rates ◽

Cancer Data ◽

The Impact

1537 Background: The LDCT LCSP was launched as a critical component of our Cancer Program to support tobacco cessation efforts and increase early detection. Initially it was offered as a self-referral low cost screening. The program was expanded when the Affordable Care Act and Center for Medicare/Medicaid Services covered it as a preventative services benefit in January 2015. Methods: 9 LDCT LCSP locations were implemented between 2014-September 2016. Program data are submitted to the American College of Radiology Lung Cancer Data Registry since 2016. In 2017, a Best Practice Alert was created within our electronic health record (EHR) to alert the primary care clinician if his/her patient met criteria for a LDCT. Each of the sites managed their own programs up until September 2018 when a dedicated team (Team) of two nurses and one data support specialist was justified. The Team focus is to increase awareness of the LDCT LCSP and criteria for eligibility, improve tobacco history taking and pack year documentation in the EHR, increase smoking cessation counseling and referral, and facilitate presentation of all Lung RADS category 4 cases for review at one of our two Multidisciplinary Lung Cancer Case Conferences. Standardized management of key incidental findings was developed for coronary artery calcification, non-lung masses, thoracic aortic aneurysm, and critical pulmonary conditions. To date, we have not examined the impact of the LDCT LCSP on smoking cessation rates. All 9 program sites have been named a Screening Center of Excellence by the Lung Cancer Alliance. Results: In 2016, 1849 LDCT Screenings were performed, 4701 (154% increase) in 2017 and 7154 (52.5% increase) in 2018. Cancer Detection rates were 1.3% in 2016, 1.8% in 2017 and 1.3% for January-June 2018. Cancer registry data reports a 9% increase in Stage 0, 1, 2A and a 7.2% decrease in Stage IV at time of diagnosis from 2014-2017. Conclusions: The implementation of a LDCT LCSP has increased the percentage of patients diagnosed at an earlier stage of lung cancer. With standardized management of key incidental findings, we anticipate improvement in early detection and management of cardiac and pulmonary diseases.

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