Smoking cessation intervention during lung screening may encourage quitting

A smoking cessation intervention, introduced as part of lung health screening, may encourage quitting in about 30 percent of smokers, results of the UK-based YESS* trial showed.

“Smoking is the biggest contributor to lung cancer around the world and smoking cessation is the most effective way we can reduce lung cancer mortality,” said Professor Rachael Murray from the University of Nottingham, Nottingham, UK, who presented the findings at WCLC 2022.

“Quit rates were considerably higher 3 months after the lung health check regardless of adding the personalized intervention, reinforcing the need for continued support,” she noted.

All current smokers attending lung health screening in the Yorkshire Lung Screening Trial were offered immediate consultation with a smoking cessation practitioner and behavioural counselling, pharmacotherapy and/or e-cigarettes according to individual preference for 4 weeks, and information on the YESS trial (n=1,609**). The 1,003 individuals who agreed to participate in the YESS trial (mean age 65 years, 50 percent male) were randomized to continue this standard treatment from week 4 (following carbon monoxide monitoring to assess cessation status; n=476 [control group]) or receive the intervention which included information and CT images of their own heart and lungs plus supportive communication from a trained specialist (n=527) for 12 weeks.

Four weeks after the lung health check, 16.5 percent had 7-day validated point-prevalent abstinence.

At 3 months, there was no significant difference in smoking cessation rates, as per 7-day validated point-prevalent abstinence, between the intervention and control groups (33.6 percent vs 30.0 percent; unadjusted odds ratio [OR], 1.17, 95 percent confidence interval [CI], 0.90–1.54; p=0.229). [WCLC 2022, abstract 1863]

“[However,] the intervention appeared to be significantly beneficial to the female population,” said Murray. At 3 months, 33.9 percent of women in the intervention group had 7-day point-prevalent abstinence compared with 23.1 percent in the control group (OR, 1.70; p=0.008). Individuals with a positive or indeterminate scan result were also more likely to quit smoking, she added. Age, type of pharmacotherapy, and booklet content (presence or absence of emphysema, coronary artery calcification) did not affect cessation results.

Seven-day validated point-prevalent abstinence also did not significantly differ between the intervention and control groups at 12 months (29.2 percent vs 28.6 percent; OR, 1.03, 95 percent CI, 0.78–1.36; p=0.82), nor did self-reported 7-day point-prevalent abstinence at 3 months (39.7 percent vs 38.0 percent; OR, 1.08; p=0.55) or 12 months (31.9 percent vs 31.7 percent; OR, 1.01; p=0.958).

“Lung cancer screening offers a fantastic opportunity to diagnose lung cancer at an earlier stage and improve treatment outcomes,” said Murray.

“While only 1–2 percent of individuals who undergo screening will be diagnosed with lung cancer, about 30–40 percent who undergo screening have a treatable condition in the form of tobacco dependence,” she continued.

“Individuals may not be ready to quit at the point of the lung health check and that is evidenced by the fact that our quit rates increased from 4 weeks to 3 months … What is really encouraging is we’re still seeing quit rates of around 30 percent at 12 months which is a really good long-term indicator,” noted Murray.

“The question remains [on whether there] is an additional benefit to be gained from adding personalized interventions and using the heart and lung images,” she said.