Effect of Lung Cancer Screening on Smoking Cessation

BOSTON — Are those with high-risk smoking histories more likely to quit after participation in annual lung cancer screening?

That’s the question raised by a recent study published online by JAMA Internal Medicine.1

The study, led by Massachusetts General Hospital researchers and including participation from the VA Boston Healthcare System, found that answer appears to depend on the level of support given by patients’ primary care providers.

Just asking about smoking isn’t enough, however, according to the research. Providers need to provide more direct assistance, such as talking about how to quit smoking, recommending or prescribing nicotine replacement or pharmaceutical aids and following up on recommendations.

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Gracie Hoal, a nurse practitioner at VA’s Comprehensive Mesothelioma Center in Los Angeles, takes a listen to the lungs of George McDermott, an 84-year-old Korean War Veteran who served in the Navy. Photo by Svetlana Kotova

“Our findings demonstrate the importance of clinicians’ active assistance — referring patients to counseling, prescribing a stop-smoking medication and following up to see how they are doing — in increasing the likelihood that patients will quit smoking,” said lead author Elyse R. Park, PhD, MPH. “While all of the participants in this study had sought screening for lung cancer and their primary care physicians were aware of that screening and its results, only half of these high-risk smokers reported that their PCPs even talked to them about how to quit smoking, and even fewer received the level of help we now know can make a critical difference.”

For the study, researchers analyzed data collected in the National Lung Screening Trial (NLST), a 2011-published study that compared two screening methods — standard X-ray studies and low-dose CT screens — for early detection of lung cancer in patients with long-term smoking histories. Results of that study led to a U.S. Preventive Services Task Force recommendation in 2013 that high-risk individuals — those aged 55 to 80 with a 30 pack-year (pack a day for a year) smoking history — receive low-dose CT screening annually. Earlier this year, Medicare decided to cover the costs of the screening for appropriate patients.

Yet, the effect of screening on smoking cessation efforts had not been measured, according to study authors.

To address that question, they analyzed data from assessment questionnaires completed at six-month intervals after screening by NLST participants who had not received a lung cancer diagnosis. Participants reported having smoked at some time during the previous six months and had visited their primary care provider during that period.

The 1,668 participants who reported they had stopped smoking since the previous assessment were compared to an equivalent group who still smoked. The comparison found little difference between the participants who had quit smoking and those who had not, in terms of whether their providers had provided simply talked to them about smoking cessation. For those who received assistance in doing so, however, likelihood that a participant would quit increased by 40%, and the chance of successful quitting increased by 46%, according to study results.

1 Park ER, Gareen IF, Japuntich S, Lennes I, Hyland K, DeMello S, Sicks JD, Rigotti NA. Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial. JAMA Intern Med. 2015 Sep 1;175(9):1509-16. doi: 10.1001/jamainternmed.2015.2391. PubMed PMID: 26076313.

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