Despite significant advancements in cancer therapy, the number-one stopper of lung cancer remains the most basic intervention: quitting smoking. Unfortunately, for long-term smokers, that intervention can sometimes be the most challenging.
According to data presented during the International Association for the Study of Lung Cancer (IASLC) 2022 World Conference on Lung Cancer, however, a personalized approach to smoking cessation has helped more than one-third of participants in a lung cancer screening program accomplish that goal.1
Results of the Yorkshire Enhanced Stop Smoking Study (YESS), which enrolled more than 1,000 smokers undergoing lung cancer screening, showed 7-day abstinence rates of 33.6% in the personalized intervention group and 30.3% in the control arm 3 months after attending a lung health check. Of note, subgroup analyses also showed that the intervention was significantly more effective in female vs male trial participants, the study authors reported.
“The presence of a co-located stop smoking service and offer of immediate, opt-out delivery of behavioral and pharmacologic support for quitting resulted in high uptake by people who smoke and attended a lung screening event,” said Rachael L. Murray, PhD, Professor of Population Health at the University of Nottingham, United Kingdom, who presented these data. “Quit rates were considerably higher 3 months after the lung health check, regardless of adding the personalized intervention, reinforcing the need for continued support.”
Rachael L. Murray, PhD
As Prof. Murray explained, smoking is the biggest contributor to lung cancer, and smoking cessation remains the most effective way to reduce lung cancer mortality. Although just 2% of people attending a lung cancer screening will receive a lung cancer diagnosis, she added, approximately 30% of people have a treatable condition in the form of tobacco dependence.
“Modeling work in the United States has shown that the addition of a tobacco control intervention will decrease overall deaths by 14% and increase the overall number of life years gained by 81%,” Prof. Murray continued. “Clearly, there are fantastic gains to be made with this type of intervention.”
To test the effectiveness of a personalized approach to smoking cessation, Prof. Murray and colleagues developed the YESS trial. It offered support on an opt-out basis to all eligible smokers attending a lung health check event, which included low-dose computed tomography (CT) screening.
The smoking cessation program involved nicotine replacement therapy, e-cigarettes, varenicline, and bupropion as well as counseling and behavioral support. At 4 weeks, investigators validated smoking status with a carbon monoxide exhalation test.
Participants who consented to the study were then randomly assigned to the same program for an additional 8 weeks (the control arm) vs the same program plus personalized support (the intervention arm). The personalized intervention included scripted behavioral support delivered by a trained smoking cessation practitioner and a booklet containing CT images of the participants’ own heart and lungs with highlighted areas of damage (eg, emphysema and coronary artery calcification).
The primary outcome in the trial was a self-reported, carbon monoxide–validated test of smoking cessation 3 months after the initial lung health check and 2 months after randomization in the YESS trial. Secondary outcomes included carbon monoxide–validated cessation at 4 weeks and 12 months as well as self-reported cessation at 4 weeks, 3 months, and 12 months after the event.
High Rates of Smoking Cessation Underscore Need for Continued Support
As Prof. Murray reported, a total of 1,003 smokers participated in the YESS trial. At 3 months after the initial lung health check, validated 7-day abstinence rates were 33.6% in the intervention group and 30% in the control group. At 12 months after the lung health check, abstinence rates remained high (29.2% for the intervention group vs 28.6% for the control).
“If people have quit for 12 months, that’s a really good indicator that this is long-term behavior and not a short-term reaction to the lung health check or the lung cancer screening,” Prof. Murray explained.
Prof. Murray and colleagues found no significant effect of the personalized booklet containing CT images on smoking cessation rates. However, investigators noted a significant interaction involving sex, with female study participants being far more likely to quit smoking at 3 and 12 months in the personalized intervention arm than with standard of care (34% vs 23%).
“Integrating a quit smoking intervention with a lung health check was positively received by both patients and staff,” Prof. Murray concluded. “We achieved good rates of smoking cessation, but questions remain about the intervention’s generalizability.
“A brief intervention is unlikely to be effective,” she added. “Participants with long smoking histories need a real holistic and high-intensity intervention.”
DISCLOSURE: Prof. Murray reported no conflicts of interest.
1. Murray RL, Brain K, Britton J, et al: Personalised smoking cessation support in a lung cancer screening programme: The Yorkshire Enhanced Stop Smoking Study (YESS). 2022 World Conference on Lung Cancer. Abstract PL03.03. Presented August 8, 2022.