Longer counseling improved tobacco abstinence in older patients screened for lung cancer
Abstinence was more common at six months in those assigned to receive eight sessions of telehealth counseling over 12 weeks versus four sessions over four weeks, a trial found, but no difference was seen in those offered two versus eight weeks of free nicotine replacement therapy or those offered screening and referral for social determinants of health.
Patients who smoked and were scheduled for lung cancer screening were more likely to abstain from tobacco at six months if they received more sessions of tobacco cessation counseling, according to a recent trial.
Researchers in Massachusetts performed a 2 × 2 × 2 factorial randomized clinical trial among adults ages 50 to 80 years to evaluate whether integrating tobacco treatment into lung cancer screening could increase smoking cessation. English- and Spanish-speaking patients who were scheduled for lung cancer screening at 11 outpatient imaging sites from April 2019 to June 2023 were randomized to eight groups of a multicomponent intervention: duration of telehealth counseling offered (four sessions over four weeks vs. eight sessions over 12 weeks), duration of free nicotine replacement therapy (two weeks vs. eight weeks), and offer to screen for social determinants of health (SDOH) and refer to community-based resources (yes or no). The study's primary outcome was self-reported seven-day tobacco abstinence at six-month follow-up. The results were published March 3 by JAMA Internal Medicine.
Six hundred forty-two patients were included in the study. Overall, 10.4% identified as Black, 7.3% identified as Hispanic, and 84.1% identified as White. The mean age was 64 years, and 55.8% were female. The mean number of cigarettes smoked daily was 16.2, and 75.4% of patients said they smoked within 30 minutes after waking up. At six months, self-reported seven-day abstinence from tobacco was higher for those offered eight versus four counseling sessions over 12 versus four weeks (17.3% vs. 11.7%; risk difference, 5.6 [95% CI, 0.1 to 11.0]; P=0.045) but did not differ significantly by duration of free nicotine replacement therapy or offer of SDOH screening and referral.
The researchers noted that the trial was affected by the COVID-19 pandemic and that uptake of community resources was low, among other limitations. They concluded that their randomized clinical trial among patients who currently smoked found greater tobacco abstinence at six months with longer duration of counseling but no effect with longer provision of free nicotine replacement therapy or with offers of SDOH screening and referral. “Future work might explore clinic systems integration to promote enrollment and improve outcomes, extended and possibly group treatment, medication choice, and navigation to support SDOH screening and resource use,” they wrote.