The Program for Lung Cancer Screening and Tobacco Cessation trial tested different adaptive interventions based on the evidence-based Tobacco Longitudinal Care (TLC) program, in part to learn how best to incorporate TLC into annual lung cancer screening as a smoking cessation standard. The findings were reported in a recent study published by Fu et al in JAMA Pulmonary Medicine.
Background
Lung cancer is associated with the highest incidence of death of any cancer in the United States, and 80% of lung cancer deaths are linked to smoking. While lung cancer screenings may play a critical role in prevention and treatment of the disease and 15 million U.S. individuals qualify for yearly screenings, over half those eligible for screenings are still actively smoking. Without standard smoking cessation measures in place, the benefits of screening are not fully realized. To that end, the evidence-based Tobacco Longitudinal Care (TLC) program consists of frequent telephone coaching and over-the-counter combination nicotine replacement therapy.
Study Methods and Results
In the new Program for Lung Cancer Screening and Tobacco Cessation (PLUTO) trial, the researchers assessed the efficacy of different adaptive interventions based on the TLC program—in part to learn how best to incorporate TLC initiatives into annual lung cancer screenings as a smoking cessation standard. The researchers then examined the effect of adding a referral for prescription medication therapy management to the TLC program in participants who did not cease smoking after their initial TLC treatment as well as the effect of decreasing the intensity of TLC treatment among participants who did cease smoking after their initial treatment.
The study results included the following findings:
- After initial TLC treatment, 80% of the participants had not responded to treatment and 20% of them had responded to treatment, demonstrating early success at smoking cessation.
- After 18 months of follow-up, the participants undergoing TLC interventions demonstrated a 24% rate of cessation.
- Among those who did not respond to their initial TLC treatment, the cessation rate for participants who received a referral for medication therapy management was similar to the rate for participants who received TLC treatment without medication therapy management.
- Among participants who did respond to their initial TLC treatment, the cessation rate for those receiving TLC treatment quarterly was 44% compared with 59% among those receiving TLC treatment monthly.
Conclusions
The researchers suggested that the TLC program was most effective when implemented without modification and may not need additional referrals. They found that integrating the TLC program with lung cancer screenings was feasible and associated with clinically meaningful cessation rates.
“If we do not help [individuals] quit smoking, we will not adequately reap the benefits of lung cancer screenings,” underscored lead study author Steven Fu, MD, MSCE, Professor at the University of Minnesota Medical School and a member of the Masonic Cancer Center. “The PLUTO trial shows that we can deliver both intensive behavioral treatment and medications to help [individuals] quit by integrating a longitudinal tobacco cessation care program into the lung cancer screening setting,” he concluded.
Although further research may still be needed to identify appropriate implementation strategies, the researchers recommended that health systems consider integrating longitudinal tobacco cessation care into the lung cancer screen setting to potentially improve outcomes for patients who continue smoking.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
