Tobacco Cessation in Lung cancer

 3.6. The Importance of Tobacco Cessation

Tobacco is a known cause of various types of tumors, accounting for approximately 85% of lung cancer cases and 30% of cancer mortality [84].

Optimizing smoking cessation services within an LDCT lung cancer screening program has the potential to improve the cost-effectiveness and the overall efficacy [85].

However, there is limited evidence regarding the optimal design and integration of tobacco cessation services.

A personalized intervention booklet, utilizing LDCT scan images, has been developed for delivery by trained smoking cessation practitioners. The results highlight the benefits of co-development during intervention creation and emphasize the need for further evaluating its effectiveness [86].

In a study by Park et al. [86], the impact of counseling using the 5As approach (Ask about smoking, Advise to quit, Assess readiness to quit, Assist with tobacco dependence treatment, and Arrange follow-up) on smoking cessation was evaluated. The study focused on a subset of smokers enrolled in the National Lung Screening Trial (NLST). The results showed that the “assist” and “arrange” steps of 5As counseling were associated with increased odds of quitting at 12 months.

In a study by Bade et al. [87], smoking cessation rates were compared between patients who underwent LDCT screening and those who did not. The study revealed higher smoking cessation rates among patients who attended counseling sessions in the LDCT screening group at 12 months (14.6%) and 24 months (12.9%) compared to those who did not attend counseling (12 months: 6.7%, 24 months: 7.6%, p-values from the analysis: p < 0.0001 and p = 0.002, respectively).

In order to be effective, lung cancer screening requires a multidisciplinary approach, encompassing individualized risk assessment, shared decision making, smoking cessation, structured reporting, high-quality multi-specialty cancer care, and reliable follow-up. Specialized organizations have outlined the key components and metrics that screening programs should incorporate. Ongoing research focuses on long-term outcomes, the refinement of screening criteria, and the use of biomarkers for early cancer detection [88].

A quasi-experimental study by Luh et al. examined a screening program emphasizing primary prevention by encouraging smoking cessation [89]. The study found that patients who received counseling from physicians and nurses showed greater odds of advancing in terms of readiness to quit compared to a control group (OR 2.27, 95% CI 1.07–4.84), while patients who received a smoking cessation leaflet had no significant difference (OR 0.99, 95% CI 0.44–2.25). [90].

Zeliadt et al. conducted a pilot feasibility trial to evaluate the impact of proactive outreach telephone counseling on behavioral cessation support and quit rates [90]. The study showed that patients who received the intervention had higher rates of using behavioral cessation support programs than the control group (44% vs. 11%, RR 4.1, 95% CI 1.7–9.9).

Lung cancer screening could prompt current smokers to reflect on their health and might present an opportunity to engage them in discussions about smoking cessation.

Ref

Healthcare (Basel). 2023 Jul 21;11(14):2085. doi: 10.3390/healthcare11142085

Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation

Daniela Amicizia 1,2, Maria Francesca Piazza 1,*, Francesca Marchini 1, Matteo Astengo 1, Federico Grammatico 1,2, Alberto Battaglini 1, Irene Schenone 1, Camilla Sticchi 1, Rosa Lavieri 1, Bruno Di Silverio 1, Giovanni Battista Andreoli 1, Filippo Ansaldi 1,2

Editor: Clara Benna