A groundbreaking randomized trial has demonstrated that incorporating comprehensive smoking cessation services directly into lung cancer screening programs significantly improves quit rates among smokers. The study, led by Dr. Paul Cinciripini at the University of Texas MD Anderson Cancer Center, reveals a marked advantage of integrated cessation support over traditional referral-based approaches.
Superior Outcomes with Integrated Care
The research showed impressive results for patients receiving fully integrated care, with 37.1% achieving tobacco abstinence at 3 months and 32.4% maintaining cessation at 6 months. This integrated approach, which combined 12-week nicotine replacement therapy or prescription medications with specialized counseling, significantly outperformed the standard quitline referral method, which achieved quit rates of 25.2% and 20.5% at 3 and 6 months respectively (OR 1.75 at 3 months, OR 1.86 at 6 months, both P=0.01).
Study Design and Implementation
The trial, conducted from July 2017 to June 2022, enrolled 630 participants who smoked a median of 20 cigarettes daily. The study compared three intervention levels:
- Full integration within the lung cancer screening program
- A hybrid model combining quitline referral with clinician-prescribed therapy
- Standard quitline referral with minimal program involvement
The integrated care model provided patients with eight counseling sessions utilizing cognitive behavioral therapy and motivational interviewing techniques, alongside comprehensive medication options including combination therapies.
Hybrid Approach Shows Promise
A notable finding was the effectiveness of the hybrid intervention, which achieved quit rates of 27.1% at 3 months and 27.6% at 6 months. While not as successful as the fully integrated approach, this model offers a more resource-efficient alternative for facilities with limited capabilities.
Clinical Implications and Future Applications
"For those who smoke, lung cancer screening presents a critical opportunity for us to support them in quitting," stated Dr. Cinciripini. The success of this approach suggests potential applications beyond lung cancer screening, including treatment programs for PTSD, cancer, cardiovascular disease, and diabetes.
Dr. Judith Prochaska of Stanford University, in an accompanying editorial, emphasized the significance of these findings, noting that approximately 60% of U.S. patients eligible for lung cancer screening currently use tobacco.
Implementation Considerations
While the integrated care model showed superior results, its resource-intensive nature may present implementation challenges for some facilities. The program required dedicated tobacco treatment specialists, trained counselors, and clinicians capable of providing comprehensive care.
Joseph Spanier, MSPAS, PA-C, from Fox Chase Cancer Center, highlighted the importance of trained tobacco treatment professionals in providing individualized treatment plans addressing both medical and behavioral aspects of smoking cessation.
The study's findings remained consistent across patient subgroups, including those with psychiatric comorbidities, suggesting broad applicability of the integrated care model. However, researchers noted limitations including a predominantly non-Hispanic white study population and pandemic-related modifications to outcome verification methods.
