Timing is Key: Smoking Cessation Successful When Tele-Counseling and Lung Cancer Screening Are Paired

Patients who receive telephone-based smoking cessation counseling at the time of lung cancer screening are more likely to quit smoking, according to preliminary results of a trial published in the journal Lung Cancer.

The findings are so compelling that the National Institutes of Health (NIH) has granted funds for a larger trial to study telephone-based smoking cessation counseling, a program it feels should part of the screening programs.

In 2013, the US Preventive Services Task Force put out lung cancer recommendations which suggested that adults aged 55-80 who had smoked long enough to have accumulated at least 30 pack years (such as smoking 1 pack per day for 30 years, or 2 packs per day for 15 years) should have annual low dose CT lung cancer screening tests. The hope is that these screenings will increase early intervention so disease can be more effectively treated.

The study’s lead researcher Kathryn L. Taylor, Ph.D., a behavioral scientist and professor of oncology at Georgetown Lombardi Comprehensive Cancer Center in Washington, DC, explained the importance of the timing and the setting of this intervention as an opportunity to make “a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related disorders.”

“We found that at this teachable moment — a time when smokers are thinking about their health and may be ready to make a change — offering help makes a difference, and may help save lives,” she said.

Researchers enrolled 92 patients from three centers — MedStar Georgetown University Hospital in Washington, DC, Hackensack University Medical Center in New Jersey and Lahey Hospital and Medical Center in Massachusetts. Patients were randomized into to two groups, 46 patients received telephone counseling and 46 patients received standard of care — which consisted of a list of free and low-cost cessation resources. Each group had an equal number of patients with abnormal screening findings, potentially precancerous lesions or chronic obstructive pulmonary disease (COPD), patients with minor abnormalities on their screen, and patients with normal results. Neither group had patients who were diagnosed with lung cancer.

The first session of telephone counseling began after patients received their screening results, and that was followed by six 10 to 15-minute-long sessions over the next three months. Counseling consisted of “motivational intervention,” according to Charlotte Hagerman, a trained tobacco treatment specialist and one of the telephone counselors.

At the end of the study period, eight patients (17 percent) from the telephone counseling group had stopped smoking compared to only two patients (4 percent) in the standard care group. A nicotine saliva test was given in order to confirm that patients had in fact quit.

“Everyone acknowledged that smoking is harmful to their health, said Hagerman, “but some people thought it was too late to change their fate. Counseling helped them understand that it is not too late.”

A number of patients were ready to quit and were excited to receive the counseling, explained Hagerman. However, Taylor added that over half of the patients said in their first session that they were not ready to quit, yet some did end up quitting.

“This finding indicates that it is important to offer the cessation intervention to everyone who undergoes lung cancer screening, and not only those who are already considering quitting,” Taylor said. “This is exactly what we hope for — to be able to reach the people who are not already planning to quit on their own.” She also mentioned that this counseling could be an effective way to reach and engage smokers who had not sought out cessation help.