Engaging Patients in Smoking Cessation Treatment within the Lung Cancer Screening Setting: Lessons Learned from an NCI SCALE Trial

Randi M Williams, Ellie Eyestone, Laney Smith, Joanna G Philips, Julia Whealan, Marguerite Webster, Tengfei Li, George Luta, Kathryn L Taylor, On Behalf Of The Lung Screening Tobacco Health Trial, Randi M Williams, Ellie Eyestone, Laney Smith, Joanna G Philips, Julia Whealan, Marguerite Webster, Tengfei Li, George Luta, Kathryn L Taylor, On Behalf Of The Lung Screening Tobacco Health Trial

Abstract

Offering smoking cessation treatment at lung cancer screening (LCS) will maximize mortality reduction associated with screening, but predictors of treatment engagement are not well understood. We examined participant characteristics of engagement in an NCI SCALE cessation trial. Eligible LCS patients (N = 818) were randomized to the Intensive arm (8 phone counseling sessions +8 weeks of nicotine replacement therapy (NRT)) vs. Minimal arm (3 sessions + 2 weeks of NRT). Engagement was measured by number of sessions completed (none, some, or all) and NRT mailed (none vs. any) in each arm. In the Intensive arm, those with ≥some college (OR = 2.1, 95% CI = 1.1, 4.0) and undergoing an annual scan (OR = 2.1, 95% CI = 1.1, 4.2) engaged in some counseling vs. none. Individuals with higher nicotine dependence were more likely (OR = 2.8, 95% CI = 1.3, 6.2) to request NRT. In the Minimal arm, those with higher education (OR = 2.1, 95% CI = 1.1, 3.9) and undergoing an annual scan (OR = 2.0, 95% CI = 1.04, 3.8) completed some sessions vs. none. Requesting NRT was associated with more pack-years (OR = 1.9, 95% CI = 1.1, 3.5). Regardless of treatment intensity, additional strategies are needed to engage those with lower education, less intensive smoking histories, and undergoing a first scan. These efforts will be important given the broader 2021 LCS guidelines.

Keywords: intervention engagement; lung cancer screening; smoking cessation; tobacco treatment.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
(a). Counseling engagement by study arm. Note: For the Intensive arm: none (0 sessions), some (1–7 sessions), and all (8 sessions). For the Minimal arm: none (0 sessions), some (1–2 sessions), and all (3 sessions). (b). Nicotine replacement therapy engagement by study arm. Note: For the Intensive arm: none (no NRT) and some NRT (2 to 8 weeks of NRT). For the Minimal arm: none (no NRT) and some (2 weeks of NRT).

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