Lung Screening, Tobacco, and Health (LSTH) Trial data

ABSTRACT Background. Lung cancer mortality is reduced via low-dose CT screening and treatment of early-stage disease. Evidence-based smoking cessation treatment in the lung screening setting can further reduce mortality. We report the results of a cessation trial from the NCI’s SCALE collaboration. Methods. Eligible patients (N=818) aged 50-80 were randomized (May 2017-January 2021) to the Intensive vs. Minimal arms (8 vs. 3 phone sessions plus 8 vs. 2 weeks of nicotine patches, respectively). Bio-verified (primary) and self-reported 7-day abstinence rates were assessed 3-, 6-, and 12-months post-randomization. Logistic regression analyses evaluated the effects of study arm. All statistical tests were two-sided. Results. Participants reported 48.0 (SD=17.2) pack-years and 51.6% were not ready to quit in <30 days. Self-reported 3-month quit rates were significantly higher in the Intensive vs. Minimal arm (14.3% vs. 7.9%; OR=2.00, 95% confidence interval [CI] = 1.26,3.18). Bio-verified abstinence was lower but with similar relative differences between arms (9.1% vs. 3.9%; OR=2.70, 95% CI = 1.44, 5.08). Compared to the Minimal arm, the Intensive arm was more effective among those with greater nicotine dependence (OR=3.47, 95% CI = 1.55, 7.76), normal screening results (OR=2.58, 95% CI = 1.32, 5.03), high engagement in counseling (OR=3.03, 95% CI = 1.50, 6.14) and patch use (OR=2.81, 95% CI = 1.39, 5.68). Abstinence rates did not differ significantly between arms at 6-months (OR=1.2, 95% CI = 0.68, 2.11) or 12-months (OR=1.4, 95% CI = 0.82, 2.42). Conclusions. Delivering intensive telephone counseling and nicotine replacement with lung screening is an effective strategy to increase short-term smoking cessation. Methods to maintain short-term effects are needed. Even with modest quit rates, integrating cessation treatment into lung screening programs may have a large impact on tobacco-related mortality.