Success of Smoking Cessation When Paired With Lung Cancer Screening

Pam Harrison

September 11, 2019

BARCELONA, Spain — Smoking cessation programs in general persuade probably at best about 10% of participants to quit, but a new approach has raised this to 27%. 

That improvement was reported here at the IASLC World Conference on Lung Cancer by a team of researchers from Vancouver, British Columbia, Canada.

The team paired their smoking cessation program with their lung cancer screening trial, taking the view that an individual's enrollment into the trial is a valuable teaching moment for an essentially captive audience.

"Traditionally, the way we approach smoking cessation is that you ask patients about their smoking, you advise them to stop, then you assess them by saying, 'Would you consider stopping smoking within the next 30 days?' " lead author Renelle Myers, MD, University of British Columbia in Vancouver, told Medscape Medical News.

The approach taken by the Vancouver QuitNow team is quite different, she said.

At the moment people enter into the screening program, they are advised in a 10-minute face-to-face interaction about the benefits of stopping smoking and are automatically referred to QuitNow, a provincial telephone-based smoking cessation line.

"People can opt out of the program if they aren't ready," Myers noted.

However, in what can only be considered a recalcitrant group of patients with an average of some 42 pack-years of smoking, the opt-out rate among 600 smokers currently enrolled in the program has been quite low, she said. The majority (87%) of smokers agreed to the automatic referral to the QuitNow program, and accepted some form of cessation service, including telephone counseling, text messaging, online coaching, pharmacotherapy, or a combination of services.

"Smoking is not a lifestyle choice or a habit; it's a chronic addition, and cigarettes are the most effective drug delivery system ever," Myers observed.

Moreover, physicians would never ask a patient with newly diagnosed diabetes, for example, if they want to think about treating their diabetes within the next 30 days, she added.

By treating smoking like the chronic illness it is, this team found their relatively aggressive, though nonjudgmental strategy, has resulted in a 27% quit rate — "which might not sound like much but it's actually very high," Myers said. 

As for the lung cancer screening itself, Myers can only point to the success of their own BC Lung Screen Trial, where approximately 70% of the cancers that have been diagnosed on screening were stage 1 — and potentially curable for life.

"Immunotherapy may be the most exciting thing that has happened in the drug world in lung cancer of late, but lung cancer screening is going to change the landscape of lung cancer provided we can just roll it out," she said. 

Indeed, Myers and colleagues are already taking it to the next level: they are beginning to introduce a smoking cessation program for all cancer patients in multiple cancer centers in BC.

"It's really going to be part of their first-line treatment and it is in all cancer types, not just smoking-related cancer," she explained.

In 2014, a large meta-analysis involving hundreds of studies showed that if patients stop smoking at the time of cancer diagnosis — this is all cancers, she reiterated, not just lung cancer — their chances of dying are reduced by 30% to 40%.

"What else gives you a mortality reduction of 30% to 40%?" Myers asked. "We're only just now getting aggressive about smoking cessation."

The researchers have disclosed no relevant financial relationships.

IASLC World Conference on Lung Cancer (WCLC) 2019: Abstract OA09.01. Presented September 9, 2019.

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