Tobacco Treatment in the Context of Lung Cancer Screening

Introduction: Many barriers exist to integrating smoking cessation into delivery of lung cancer screening including limited provider time and patient misconceptions.Aims: To demonstrate that proactive outreach from a telephone counsellor outside of the patient's usual care team is feasible and acceptable to patients.Methods: Smokers undergoing lung cancer screening were approached for a telephone counselling study. Patients agreeing to participate in the intervention (n = 27) received two telephone counselling sessions. A 30-day follow-up evaluation was conducted, which also included screening participants receiving usual care (n = 56).Results/Findings: Most (89%) intervention participants reported being satisfied with the proactive calls, and 81% reported the sessions were helpful. Use of behavioural cessation support programs in the intervention group was four times higher (44%) compared to the usual care group (11%); Relative Risk (RR) = 4.1; 95% CI: 1.7 to 9.9), and seven-day abstinence in the intervention group was double (19%) compared to the usual care group (7%); RR = 2.6; 95% CI: 0.8 to 8.9).Conclusions: This practical telephone-based approach, which included risk messages clarifying continued risks of smoking in the context of screening results, suggests such messaging can boost utilisation of evidence-based tobacco treatment, self-efficacy, and potentially increase the likelihood of successful quitting.

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Personalized Intervention Program: Tobacco Treatment for Patients at Risk for Lung Cancer

The Journal of Smoking Cessation ◽

10.1017/jsc.2017.24 ◽

2017 ◽

Vol 13 (4) ◽

pp. 244-247 ◽

Cited By ~ 2

Author(s):

Krysten W. Bold ◽

Benjamin A. Toll ◽

Brenda Cartmel ◽

Bennie B. Ford ◽

Alana M. Rojewski ◽

...

Keyword(s):

Lung Cancer ◽

At Risk ◽

Smoking Cessation ◽

Cancer Screening ◽

High Risk ◽

Standard Care ◽

Tobacco Cessation ◽

Lung Cancer Screening ◽

Tobacco Treatment ◽

Patients At Risk

Background:Lung cancer screening and tobacco treatment for patients at high-risk for lung cancer may greatly reduce mortality from smoking, and there is an urgent need to improve smoking cessation therapies for this population.Aims:The purpose of this study is to test the efficacy of two separate, sequential interventions to promote tobacco cessation/reduction compared to standard care in smokers considered high-risk for lung cancer.Methods:The study will recruit 276 current smokers attending a lung cancer screening clinic or considered high-risk for lung cancer based on age and smoking history across two sites. Patients first will be randomized to either standard tobacco treatment (8 weeks of nicotine patch and five individual counselling sessions) or standard tobacco treatment plus personalized gain-framed messaging. At the 8-week visit, all patients will be re-randomized to receive biomarker feedback or no biomarker feedback. Repeated assessments during treatment will be used to evaluate changes in novel biomarkers: skin carotenoids, lung function, and plasma bilirubin that will be used for biomarker feedback. We hypothesize that personalized gain-framed messages and receiving biomarker feedback related to tobacco cessation/reduction will improve quit rates and prevent relapse compared to standard care. Primary outcomes include 7-day point-prevalence abstinence verified with expired carbon monoxide at 8 weeks and mean cigarettes per day in the past week at 6 months.Conclusions:Study findings will inform the development of novel interventions for patients at risk for lung cancer to improve smoking cessation rates.

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Patient–Physician Discussions on Lung Cancer Screening: A Missed Teachable Moment to Promote Smoking Cessation

Nicotine & Tobacco Research ◽

10.1093/ntr/nty254 ◽

2018 ◽

Vol 22 (3) ◽

pp. 431-439 ◽

Cited By ~ 6

Author(s):

Hasmeena Kathuria ◽

Elisa Koppelman ◽

Belinda Borrelli ◽

Christopher G Slatore ◽

Jack A Clark ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Treatment Programs ◽

Teachable Moment ◽

Smoking Cessation Counseling ◽

Tobacco Treatment ◽

Physician Perspectives ◽

Promote Smoking Cessation

Abstract Introduction Little is known about whether patients and physicians perceive lung cancer screening (LCS) as a teachable moment to promote smoking cessation or the degree to which physicians in “real world” settings link LCS discussions with smoking cessation counseling. We sought to characterize patient and physician perspectives of discussions about smoking cessation during LCS. Methods We conducted a qualitative study (interviews and focus groups) with 21 physicians and 28 smokers screened in four diverse hospitals. Transcripts were analyzed for characteristics of communication about smoking cessation and LCS, the perceived effect on motivation to quit smoking, the degree to which physicians leverage LCS as a teachable moment to promote smoking cessation, and suggestions to improve patient–physician communication about smoking cessation in the context of LCS. Results Patients reported that LCS made them more cognizant of the health consequences of smoking, priming them for a teachable moment. While physicians and patients both acknowledged that smoking cessation counseling was frequent, they described little connection between their discussions regarding LCS and smoking cessation counseling. Physicians identified several barriers to integrating discussions on smoking cessation and LCS. They volunteered communication strategies by which LCS could be leveraged to promote smoking cessation. Conclusions LCS highlights the harms of smoking to patients who are chronic, heavy smokers and thus may serve as a teachable moment for promoting smoking cessation. However, this opportunity is typically missed in clinical practice. Implications LCS highlights the harms of smoking to heavily addicted smokers. Yet both physicians and patients reported little connection between LCS and tobacco treatment discussions due to multiple barriers. On-site tobacco treatment programs and post-screening messaging tailored to the LCS results are needed to maximize the health outcomes of LCS, including smoking quit rates and longer-term smoking-related morbidity and mortality.

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Abstract C52: Clinic utilization and smoking cessation practices among ethnic minority patients referred for paired lung cancer screening and tobacco treatment services at a community cancer program

10.1158/1538-7755.disp16-c52 ◽

2017 ◽

Author(s):

Ruth N. Akindele ◽

Ludmila A. Svoboda ◽

Sabrina G. Gonzalez ◽

Christopher S. Lathan

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cancer Screening ◽

Ethnic Minority ◽

Lung Cancer Screening ◽

Treatment Services ◽

Cancer Program ◽

Tobacco Treatment

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Patients’ reactions to a decision aid about lung cancer screening with low-dose spiral computed tomography: An uncontrolled trial.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1564 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1564-1564 ◽

Cited By ~ 1

Author(s):

Robert J. Volk ◽

Suzanne K. Linder ◽

Viola Leal ◽

Vance A. Rabius ◽

Paul M. Cinciripini ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Decision Aid ◽

Low Dose ◽

False Positive Rate ◽

Lung Cancer Screening ◽

Spiral Computed Tomography ◽

Spiral Computed ◽

Tobacco Treatment

1564 Background: Results from the National Lung Screening Trial (NLST) and a recent ASCO-supported systematic review concluded that screening with low-dose spiral computed tomography (LDCT) reduces lung cancer deaths among selected heavy smokers. Yet, this mortality benefit must be weighed against the potential harms of screening (e.g., high false positive rate). In anticipation of LDCT screening becoming a reimbursable preventive health service, we developed and evaluated a brief, video-based patient decision aid designed for use in clinical settings. Methods: Patients from a tobacco treatment program who were 45 to 75 years of age and had no history of lung cancer participated in the study. Measures of acceptability and ratings of the aid were included. We assessed effectiveness of the aid via knowledge about lung cancer and the benefits and risks of screening, and clarity of values using the Decisional Conflict Scale. Results: Fifty-two patients completed the study (mean age=58.5 years; mean average years smoking=34.8 years). Over 94% of patients watched the entire video, would recommend it to others, felt it held their interest, rated the content favorably, and wanted to view similar video-based aids. Acceptability was high, although 23.3% wanted more information about the NLST findings and evidence base. After viewing the aid, knowledge about lung cancer screening increased significantly (before viewing aid, 25.5% of questions answered correctly; after viewing aid, 74.8%; P<.01). The majority of patients continued to have difficulty with the question about whether all current and former smokers should be screened for lung cancer (23.1% answered correctly). Patients reported being clear about which benefits and harms of screening mattered most to them (94.1% and 86.5% were clear, respectively). Conclusions: Our decision aid was rated favorably by tobacco treatment patients. Large gains in knowledge about lung cancer screening were observed, highlighting the important informational function of the aid. Additional features under consideration for the aid include screening eligibility assessment and information about the evidence behind the screening recommendations.

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Implementation of an Evidence-Based Tobacco Use Treatment Intervention in the Context of Lung Cancer Screening

10.1093/med/9780190647421.003.0015 ◽

2018 ◽

Author(s):

Jamie S. Ostroff ◽

Donna Shelley

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Tobacco Use ◽

Lung Cancer Screening ◽

Helical Computed Tomography ◽

Evidence Based ◽

Treatment Interventions ◽

Smoking Cessation Treatment ◽

Tobacco Treatment

Lung cancer screening using low-dose helical computed tomography is now recommended for early detection of lung cancer. This case study provides an overview of a study that is testing the effectiveness of tobacco treatment interventions for high-risk smokers seeking lung cancer screening and examining factors that may influence implementation process and sustainability for delivering effective models of smoking cessation treatment in lung cancer screening settings. The focus of the case study is a description of how and why two implementation frameworks were applied to evaluate the implementation outcomes and additional multilevel factors (i.e., organization and intervention characteristics) that may influence effective implementation of evidence-based tobacco use treatment interventions in the context of lung cancer screening. Ultimately, implementation of high-quality tobacco treatment in lung cancer screening settings is likely to further reduce tobacco-related cancer morbidity and mortality.

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