The impact of computed tomography screening for lung cancer on smoking behaviors: a teachable moment?

Patients' Views on Medical Events in Lung Cancer Screening as Teachable Moments for Smoking Behaviour Change: A Systematic Review and Metasynthesis

Although medical events in lung cancer screening (LCS) such as receiving scan results or interactions with clinicians are recognised as teachable moments (TMs), the views of patients about why this is the case for smoking behaviour change remain uncertain. This systematic review and metasynthesis study is aimed at identifying the reasons why patients believed that medical events during LCS act as TMs for smoking behaviour change. A search strategy was developed for use with MEDLINE, PsycINFO, EMBASE, CINAHL-P, Web of Science databases, and Google Scholar. This helped identify qualitative and mixed-method research which mentioned patients' views of how these TMs result in smoking behaviour change. After screening, final articles were critically appraised; general characteristics and data relevant to the aims were extracted to conduct a line-of-argument metasynthesis. After screening 695 papers, 11 were included. Undergoing LCS scans was seen to act on their intrinsic motivation to reduce smoking as it served as a "wake-up call" and increased awareness of the health consequences of smoking. Receiving positive or negative LCS results resulted in cessation as it was a "health scare" and challenged smoking habits. Interactions with clinicians addressed misconceptions and signposted them to specialist cessation services. Attendees believed that the following encouraged them to change their smoking behaviour: having an intrinsic motivation to quit, their beliefs on smoking and health reframed, their negative emotions appraised, and using LCS to access specialist support. In line with the TM heuristic, these experiences provided the necessary skills, confidence, and motivation to quit. Future research should explore whether the views of the clinicians match those of the attendees to address misconceptions and further develop clinical guidelines.

"It's a decision I have to make": Patient perspectives on smoking and cessation after lung cancer screening decisions

Few studies exist showing that involvement in lung cancer screening (LCS) leads to a change in rates of cigarette smoking. We investigated LCS longitudinally to determine whether teachable moments for smoking cessation occur downstream from the initial provider-patient LCS shared decision-making discussion and self-reported effects on smoking behaviors. We performed up to two successive semi-structured interviews to assess the experiences of 39 individuals who formerly or currently smoked cigarettes who underwent LCS decision-making discussions performed during routine care from three established US medical center LCS programs.

The majority of those who remembered hearing about the importance of smoking cessation after LCS-related encounters did not report communication about smoking influencing their motivation to quit or abstain from smoking, including patients who were found to have pulmonary nodules. Patients experienced little distress related to LCS discussions. Patients reported that there were other, more significant, reasons for quitting or abstinence. They recommended clinicians continue to ask about smoking at every clinical encounter, provide information comparing the benefits of LCS with those of quitting smoking, and have clinicians help them identify triggers or other motivators for improving smoking behaviors. Our findings suggest that there may be other teachable moment opportunities outside of LCS processes that could be utilized to motivate smoking reduction or cessation, or LCS processes could be improved to integrate cessation resources.

A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting

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.

Engaging Patients in Smoking Cessation Treatment within the Lung Cancer Screening Setting: Lessons Learned from an NCI SCALE Trial

Offering smoking cessation treatment at lung cancer screening (LCS) will maximize mortality reduction associated with screening, but predictors of treatment engagement are not well understood. We examined participant characteristics of engagement in an NCI SCALE cessation trial. Eligible LCS patients (N = 818) were randomized to the Intensive arm (8 phone counseling sessions +8 weeks of nicotine replacement therapy (NRT)) vs. Minimal arm (3 sessions + 2 weeks of NRT). Engagement was measured by number of sessions completed (none, some, or all) and NRT mailed (none vs. any) in each arm. In the Intensive arm, those with ≥some college (OR = 2.1, 95% CI = 1.1, 4.0) and undergoing an annual scan (OR = 2.1, 95% CI = 1.1, 4.2) engaged in some counseling vs. none. Individuals with higher nicotine dependence were more likely (OR = 2.8, 95% CI = 1.3, 6.2) to request NRT. In the Minimal arm, those with higher education (OR = 2.1, 95% CI = 1.1, 3.9) and undergoing an annual scan (OR = 2.0, 95% CI = 1.04, 3.8) completed some sessions vs. none. Requesting NRT was associated with more pack-years (OR = 1.9, 95% CI = 1.1, 3.5). Regardless of treatment intensity, additional strategies are needed to engage those with lower education, less intensive smoking histories, and undergoing a first scan. These efforts will be important given the broader 2021 LCS guidelines.

Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment

BACKGROUND

For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes.

METHODS

In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]).

RESULTS

Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5).

CONCLUSIONS

During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.

Understanding the Associations between Smoking-Related Risk Perception, Interest in Quitting Smoking, and Interest in Lung Cancer Screening among Homeless Adult Smokers

Individuals experiencing homelessness smoke cigarettes at high rates, suffer a disproportionate incidence of lung cancer, but are unlikely to be screened to enhance early detection. Understanding correlates of lung cancer screening (LCS) interest within this vulnerable group may lend insight into prevention and treatment efforts and reduce their smoking-related morbidity and mortality. This study sought to understand how risk perception and interest in quitting smoking relate to LCS interest among homeless adults. Participants comprised a convenience sample of CO-verified current smokers (N = 310; 72.6% men, M_age = 43 + 11.7) from a homeless shelter in Dallas, TX. Participants self-reported risk perception, interest in quitting smoking, and interest in LCS. The average risk perception was 6.7 + 3.2 (range 0-10), 74.8% (n = 232) agreed or strongly agreed with interest in LCS, and 65.8% (n = 204) were interested in quitting smoking. Greater interest in quitting smoking, but not greater risk perception, was associated with greater interest in LCS (adjusted OR: 1.968, (95% CI: 1.213, 3.191), p = 0.006). Risk perception and interest in quitting smoking did not interact in their association with interest in LCS. Results suggest that homeless smokers with an interest in quitting may be receptive to LCS: a diagnostic tool by which cancers can be caught at earlier stages and prior to metastasis. However, few in the current sample would be eligible for LCS based on current guidelines; results have implications for altered screening practices among chronic smokers experiencing homelessness.

[Smoking cessation and lung cancer screening]

Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.

The effects of a short-term physician training on smoking cessation in a university pulmonary department

Objective: The objective was to evaluate the effect of a short physician training in smoking cessation on the physicians' performance of smoking cessation interventions. The effects on patients' cessation rates were analyzed as well. A further aim was to identify barriers for providing cessation interventions. The study was conducted in an acute care pulmonology department of a German university hospital. Methods: 24 physicians of the pulmonology department of a German university hospital received a two-hour training in smoking cessation. 109 pre- and 89 post-training group patients were compared with regard to the frequencies of received smoking cessation interventions (Ask, Advise, Assist) and three- and six-month abstinence rates. Physicians estimated their intervention frequencies and gave reasons for not providing cessation interventions. Results: In a multivariable analysis (p<0.05), the physicians' application of "Ask" (OR 3.28, 95% CI 1.13-9.53) and the six-month abstinence rates (OR 2.70, 95% CI 1.24-5.84) were significantly higher in the post-training group. The univariate analysis also showed a significant effect on "Assist" (OR 2.05, 95% CI 1.09-3.87). No significant effect was seen on "Advise to quit". Physicians overestimated their intervention frequencies and reported the patients' low motivation to stop, an oncological disease and palliative care situation as barriers to performing smoking cessation. Conclusion: A short physician training in a hospital department of pulmonology increases the use of guideline-based cessation strategies and may improve cessation rates. The findings show that hospital-based strategies such as physician trainings could be useful in the improvement of smoking cessation. Strategies for overcoming barriers for providing smoking cessation interventions are needed.

Smoking Cessation in the ITALUNG Lung Cancer Screening: What Does “Teachable Moment” Mean?

Background

Changes in smoking habits and predictors of smoking cessation were examined in the randomized ITALUNG lung cancer screening trial.

Methods

In three centers, eligible smokers or ex-smokers (55–69 years, ≥20 pack-years in the last 10 years) were randomized to receive annual invitation for low-dose computed tomography for 4 years or usual care. At invitation, subjects received written information for a free smoking cessation program. Quitting outcome was assessed at year 4.

Results

Among participants who completed baseline assessments and year 4 screening, higher quitting (20.8% vs. 16.7%, p = .029) and lower relapse (6.41% vs. 7.56%, p = .50) rates were observed in the active screening group as compared to the usual-care control group. Corresponding figures in the intention-to-treat analysis were as follows: 16.04% versus 14.64% (p = .059) and 4.88% versus 6.43% (p = .26). Quitting smoking was significantly associated to male gender, lower pack-years, and having pulmonary nodules at baseline. Center-specific analyses showed a threefold statistically significant higher probability to quit associated with participating in the smoking cessation program. A subsample of smokers of the scan group from one center showed higher quitting rates over 12-month follow-up as compared to matched controls from the general population who underwent the same smoking cessation program.

Conclusions

Consistently with previous reports, in the ITALUNG trial, screened subjects showed significantly higher quit rates than controls, and higher quit rates were associated with both the presence of pulmonary nodules and participating in a smoking cessation program. Maximal effect on quitting outcome was observed with the participation in the smoking cessation program.

Implications

Participating in lung cancer screening promotes smoking cessation. An effective “teachable moment” may be achieved when the smoking cessation intervention is structured as integral part of the screening clinical visits and conducted by a dedicated team of health care professionals. Standardized guidelines for smoking cessation interventions in lung cancer screening are needed.

Awareness and interest in lung cancer screening among current and former smokers: findings from the ITC United States Survey

PURPOSE

To examine the awareness of low-dose computed tomography (LDCT) lung cancer screening among a population of current and former smokers using a nationally representative sample from the United States.

METHODS

Data for this study come from Wave 9 of the International Tobacco Control (ITC) United States Survey, conducted between 2013 and 2015. Among respondents age ≥ 40 (n = 1145), a 50% random sample were asked a series of questions pertaining to lung cancer screening. This study examines awareness and screening behaviors in relationship to demographic characteristics of respondents, health beliefs, psychosocial behaviors, and smoking behaviors. Descriptive tables and χ² tests were used to examine the association between those who were aware and unaware. Logistic regression analyses were conducted, stratified on respondents' smoking status. Data were weighed to be representative of the current smoking population in the US.

RESULTS

Overall, 52% of current and former smokers reported being aware of lung cancer screening. Among the group with no prior screening, 80.6% said they would take a lung cancer screening exam if recommended by their physician. In the multivariate models, former smokers had significantly greater awareness of lung cancer screening compared to current smokers [odds ratio 1.42 (95% confidence interval 1.03, 1.97)].

CONCLUSIONS

Awareness of LDCT lung cancer screening was lower among current smokers compared to former smokers. Most smokers who had not ever been screened said they would have lung cancer screening if it were recommended by their physician, demonstrating the need for healthcare providers to encourage those eligible for screening to take the test.

Smoking-related health beliefs and smoking behavior in the National Lung Screening Trial

Understanding the association between smoking-related health beliefs and smoking cessation in the context of lung screening is important for effective cessation treatment. The purpose of the current study is to explore how current smokers' self-reported smoking-related health cognitions (e.g., self-efficacy) and emotions (e.g., worry) are related to cessation. This study utilized longitudinal data from current smokers (age 55-74) in a sub-study of the National Lung Screening Trial (NLST; 2002-2006; N = 2738). Logistic regression analyses examined associations of cessation at last assessment with smoking-related health cognitions and emotions, demographics, and two-way interactions among smoking-related health cognition and emotion variables, gender, and age. Over 37% (n = 1028) of smokers had quit at their last assessment of smoking status. Simple logistic regressions showed the likelihood of quitting was greater among participants reporting higher perceived severity of smoking-related diseases (OR = 1.17, p = .04), greater self-efficacy for quitting (OR = 1.32, p < .001), and fewer perceived barriers to quitting (OR = 0.82, p = .01). Likelihood of quitting was lower among non-Hispanic Black participants (versus non-Hispanic White participants) (OR = 0.68, p = .04) and higher among older participants (OR = 1.03, p = .002). Multiple logistic regression showed that participants reporting greater self-efficacy for quitting (B = 0.09, p = .05), fewer perceived barriers to quitting (B = -0.22, p = .01), and who were older (B = 0.03, p < .01) were more likely to quit smoking. These results suggest that, among heavy smokers undergoing lung screening, smoking-related health cognitions and emotions are associated with smoking cessation. These health beliefs must be considered an integral component of cessation in screening settings.

Using a Patient Decision Aid Video to Assess Current and Former Smokers' Values About the Harms and Benefits of Lung Cancer Screening With Low-Dose Computed Tomography

Background. Recent policy changes require discussing the potential benefits and harms of lung cancer screening with low-dose computed tomography. This study explored how current and former smokers value potential benefits and harms after watching a patient decision aid, and their screening intentions. Methods. Current or former smokers (quit within 15 years) with no history of lung cancer watched the decision aid and responded to items assessing the value of potential benefits and harms in their decision making, and their screening intentions. Results. After viewing the decision aid, participants (n = 30; mean age 61.5 years, mean 30.4 pack-year history) were well-informed (mean 80.5% correct responses) and rated anticipated regret and finding cancer early as highly important in their decision (medians >9 out of 10), along with moderate but variable concerns about false positives, overdiagnosis, and radiation exposure (medians 7.0, 6.0, and 5.0, respectively). Most participants (90.0% to 96.7%) felt clear about how they personally valued the potential benefits and harms and prepared for decision making (mean 86.7 out of 100, SD = 21.3). After viewing the decision aid, most participants (90%) intended to discuss screening with their doctor. Limitations. The study is limited to current and former smokers enrolled in a tobacco treatment program, and it may not generalize to other patient populations. Conclusions. The majority of current and former smokers were strongly concerned about anticipated regret and finding cancer early, while concerns about radiation exposure, false positives, and overdiagnosis were variable. After viewing the decision aid, current and former smokers reported strong preparedness and intentions to talk with their doctor about lung cancer screening with low-dose computed tomography.

Screening for Lung Cancer: Communicating With Patients

OBJECTIVE

The purposes of this article are to detail the experience of a single-center academic institution in applying the patient-centered approach to a lung cancer screening program and to examine how this approach can expand to other aspects of follow-up imaging of lung nodules.

CONCLUSION

As the practice of patient-centered radiology gains attention, diagnostic radiologists are findings new ways to become more involved in patient care. A lung cancer screening program is one opportunity for radiologists to consult with and educate patients.

Smoking cessation interventions within the context of Low-Dose Computed Tomography lung cancer screening: A systematic review

The integration of smoking cessation interventions (SCIs) within the context of lung cancer screening programs is strongly recommended by screening guidelines, and is a requirement for Medicare coverage of screening in the US. In Europe, there are no lung cancer screening guidelines, however, research trials are ongoing, and prominent professional societies have begun to recommend lung cancer screening. Little is known about the types and efficacy of SCIs among patients receiving low-dose computed tomography (LDCT) screening. This review addresses this gap. Based on a systematic search, we identified six empirical studies published prior to July 1, 2015, that met inclusion criteria for our review: English language, SCI for LDCT patients, and reported smoking-related outcomes. Three randomized studies and three single-arm studies were identified. Two randomized controlled trials (RCTs) evaluated self-help SCIs, whereas one pilot RCT evaluated the timing (before or after the LDCT scan) of a combined (counseling and pharmacotherapy) SCI. Among the single-arm trials, two observational studies evaluated the efficacy of combined SCI, and one retrospectively assessed the efficacy of clinician-delivered smoking assessment, advice, and assistance. Given the limited research to date, and particularly the lack of studies reporting results from RCTs, assumptions that SCIs would be effective among this population should be made with caution. Findings from this review suggest that participation in a lung screening trial promotes smoking cessation and may represent a teachable moment to quit smoking. Findings also suggest that providers can take advantage of this potentially teachable moment, and that SCIs have been successfully implemented in screening settings. Continued systematic and methodologically sound research in this area will help improve the knowledge base and implementation of interventions for this population of smokers at risk for chronic disease.

Pairing smoking-cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco

Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation.

Lung Malignancies in HIV Infection

Pulmonary malignancies are a major source of morbidity and mortality in HIV-infected persons. Non-AIDS-defining lung cancers (mostly non-small cell lung cancers) are now a leading cause of cancer death among HIV-infected persons. HIV-associated factors appear to affect the risk of lung cancer and may adversely impact cancer treatment and outcomes. HIV infection also may modify the potential harms and benefits of lung cancer screening with computed tomography. AIDS-defining lung malignancies include pulmonary Kaposi sarcoma and pulmonary lymphoma, both of which are less prevalent with widespread adoption of antiretroviral therapy.

Lung Cancer Screening, Cancer Treatment, and Addressing the Continuum of Health Risks Caused by Tobacco

Tobacco use is the largest preventable risk factor for the development of several cancers, and continued tobacco use by patients with cancer and survivors of cancer causes adverse outcomes. Worldwide tobacco control efforts have reduced tobacco use and improved health outcomes in many countries, but several countries continue to suffer from increased tobacco use and associated adverse health effects. Continued tobacco use by patients undergoing cancer screening or treatment results in continued risk for cancer-related and noncancer-related health conditions. Although integrating tobacco assessment and cessation support into lung cancer screening and cancer care is well justified and feasible, most patients with cancer unfortunately do not receive evidence-based tobacco cessation support. Combining evidence-based methods of treating tobacco addiction, such as behavioral counseling and pharmacotherapy, with practical clinical considerations in the setting of lung cancer screening and cancer treatment should result in substantial improvements in access to evidence-based care and resultant improvements in health risks and cancer treatment outcomes.

Patient's lung cancer diagnosis as a cue for relatives' smoking cessation: evaluating the constructs of the teachable moment

BACKGROUND

To understand whether patient-reported experiences with lung cancer may create teachable moments (TM) for their relatives as evidenced by shifts in their risk perceptions, affective response, and self-image and in turn, motivation to quit smoking.

METHODS

Patients at a comprehensive cancer center (n = 152) completed a survey within 6 months of lung cancer diagnosis to assess their cancer-related symptoms and openness and enumerated relatives who were smokers. Relative smokers (n = 218) then completed a survey assessing their risk perceptions, affective response, and self-image as a smoker related to the patient's diagnosis (TM mechanisms), and their motivation to quit smoking. Cross-sectional mediation and moderation analyses were conducted to explore the links between patient-reported experiences, and relatives' TM mechanisms, and motivation to quit smoking.

RESULTS

Relative-reported affect was a significant mediator of the association between patient-reported symptoms and relative smoker's desire to quit. Relatives' self-image was a significant moderator of the association between patient-reported symptoms and relative smoker's desire to quit, such that patients' reported symptoms were associated with relatives' desire to quit only when the relative smoker reported a generally positive self-image as a smoker. No evidence was found for moderated mediation. However, the link between symptoms and negative affect was moderated by perceptions of risk.

CONCLUSION

Whether smokers experience a family member's lung cancer as a TM is influenced by multiple interrelated cognitive and affective factors that warrant further exploration. Clearer understanding of these factors could inform how to re-invigorate and sustain this motivation to promote concrete actions toward smoking cessation. Copyright © 2015 John Wiley & Sons, Ltd.

Readiness of Lung Cancer Screening Sites to Deliver Smoking Cessation Treatment: Current Practices, Organizational Priority, and Perceived Barriers

INTRODUCTION

Lung cancer screening represents an opportunity to deliver smoking cessation advice and assistance to current smokers. However, the current tobacco treatment practices of lung cancer screening sites are unknown. The purpose of this study was to describe organizational priority, current practice patterns, and barriers for delivery of evidence-based tobacco use treatment across lung cancer screening sites within the United States.

METHODS

Guided by prior work examining readiness of health care providers to deliver tobacco use treatment, we administered a brief online survey to a purposive national sample of site coordinators from 93 lung cancer screening sites.

RESULTS

Organizational priority for promoting smoking cessation among lung cancer screening enrollees was high. Most sites reported that, at the initial visit, patients are routinely asked about their current smoking status (98.9%) and current smokers are advised to quit (91.4%). Fewer (57%) sites provide cessation counseling or refer smokers to a quitline (60.2%) and even fewer (36.6%) routinely recommend cessation medications. During follow-up screening visits, respondents reported less attention to smoking cessation advice and treatment. Lack of patient motivation and resistance to cessation advice and treatment, lack of staff training, and lack of reimbursement were the most frequently cited barriers for delivering smoking cessation treatment.

CONCLUSIONS

Although encouraging that lung cancer screening sites endorsed the importance of smoking cessation interventions, greater attention to identifying and addressing barriers for tobacco treatment delivery is needed in order to maximize the potential benefit of integrating smoking cessation into lung cancer screening protocols.

IMPLICATIONS

This study is the first to describe practice patterns, organizational priority, and barriers for delivery of smoking cessation treatment in a national sample of lung cancer screening sites.

China national lung cancer screening guideline with low-dose computed tomography (2015 version)

BACKGROUND

Lung cancer is the leading cause of cancer-related death in China. Results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality.

METHODS

A China national lung cancer screening guideline was developed by lung cancer early detection and treatment expert group appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China.

RESULTS

Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation.

CONCLUSIONS

A lung cancer screening guideline is provided for the high-risk population in China.

Decision making among Veterans with incidental pulmonary nodules: a qualitative analysis

PURPOSE

Among patients undergoing lung cancer evaluation for newly diagnosed, incidental pulmonary nodules, it is important to evaluate the shared power and responsibility domain of patient-centered communication. We explored Veterans' perceptions of decision making with regards to an incidentally-detected pulmonary nodule.

METHODS

We conducted semi-structured, qualitative interviews of 19 Veterans from one medical center with incidentally-detected pulmonary nodules that were judged as having a low risk for malignancy. We used qualitative description for the analysis, focusing on patients' perceptions of shared decision making with their primary care provider (PCP). Interviews were conducted in 2011 and 2012.

RESULTS

Patients almost always played a passive role in deciding how and when to evaluate their pulmonary nodule for the possibility of malignancy. Some patients felt comfortable with this role, expressing trust that their clinician would provide the appropriate care. Other patients were not satisfied with how these decisions were made with some expressing concern that no decisions had actually occurred. Regardless of how satisfied they were with the decision, patients did not report discussing how they liked to make decisions with their PCP.

CONCLUSIONS

Veterans in our study did not engage in shared decision making with their clinician. Some were satisfied with this approach although many would have preferred a shared approach. In order to reduce patient distress and improve satisfaction, clinicians may want to consider adopting a shared approach when making decisions about pulmonary nodule evaluation.

Implementing Lung Cancer Screening Using Low-Dose Computed Tomography: Recommendations From an Expert Panel

Implementation of effective and efficient population-based CT lung cancer screening will require involvement and coordination of stakeholders across the health care system.

Smoking status, service use and associated factors among Japanese cancer survivors--a web-based survey

PURPOSE

This study aims to investigate smoking status and its associated factors among Japanese cancer survivors. We stretched our focus on association with health-related behaviors other than smoking (alcohol intake, physical exercise, and social activity) and the smoking cessation strategies used by cancer survivors.

METHODS

An anonymous cross-sectional web-based survey was conducted, enrolling survivors of various types of cancer up to 10 years after diagnosis. Smoking status, socioeconomic status, health-related behaviors other than smoking, and smoking cessation resource that the participants used were evaluated. Factors associated with continuous smoking after cancer diagnosis were explored using multivariate analysis.

RESULTS

Among 168 participants who were smoking at the time of cancer diagnosis, 96 participants (57.1 %) continued smoking. Sixty-seven survivors (69.8 %) were willing to reduce or quit smoking, however, only 39 survivors (40.6 %) were provided with counseling or intervention on smoking cessation. Male gender, shorter time after cancer diagnosis, and lack of regular physical exercise associated with continuous smoking. Higher level of fear of cancer recurrence had trend-level significance of association with smoking cessation.

CONCLUSIONS

Substantial proportions of Japanese cancer survivors continue smoking after diagnosis of cancer. The majority of them are not provided with relevant information or support, despite their willingness of reducing or quitting smoking. Smoking cessation is associated with other health behaviors (i.e., physical exercise). This suggests considerable missed opportunities for health-care providers to provide cancer survivors with counseling and evidence-based interventions. Promotion of professional support on smoking cessation and education to encourage healthy behaviors are needed.

Demonstration program of population-based lung cancer screening in China: Rationale and study design

BACKGROUND

Lung cancer is the leading cause of cancer-related death and has become an enormous economic burden in China. Low-dose spiral computed tomography (LDCT) screening could reduce lung cancer mortality. The feasibility of conducting a population-based lung cancer screening with LDCT in China is uncertain.

METHODS

In 2010, a demonstration program of lung cancer screening was initiated in China. High-risk individuals were enrolled in a cluster sampling design in different centers. Participants received baseline and annual screening with spiral CT and follow-up information was collected. The objective of this program is to evaluate the feasibility of conducting population-based LDCT lung cancer screening in the Chinese context. The rates of detection, early diagnosis and treatment are defined as indicators of program performance. The optimal management strategies for nodules are explored in the Chinese context based on experiences in other studies overseas.

RESULTS

A demonstration program of ongoing prospective, multi-center, population-based lung cancer screening is being performed in China.

CONCLUSIONS

This demonstration program will provide opportunities to explore the feasibility of LDCT lung cancer screening in the Chinese setting.

Importance of Smoking Cessation in a Lung Cancer Screening Program

Early detection of lung cancer and smoking cessation interventions can decrease lung cancer mortality, but information on the effectiveness and interaction between smoking cessation and lung cancer screening is sparse and inconsistent. This review aims to synthesize recent studies in two major areas of interest. First, we explore the interactions and potential for synergies between lung cancer screening programs and smoking cessation by summarizing reported changes in smoking behavior observed in major screening trials in the United States and Europe, as well as attempts to use smoking cessation interventions to augment the benefits from lung cancer screening programs. Second, we review the interaction between smoking habits and pre/post-operative pulmonary resection outcomes, including changes in smoking behavior post-diagnosis and post-treatment. Information from these areas should allow us to maximize benefits from smoking cessation interventions through the entire lung cancer screening process, from the screen itself through potential curative resection after diagnosis.

Is a cancer diagnosis a teachable moment for the patient's relative who smokes?

PURPOSE

This study examined a cancer diagnosis, versus orthopedic surgery, as a teachable moment for recruiting smokers and treating nicotine dependence among patients' relatives.

METHODS

Cancer patients and, for comparison, orthopedic patients at the University of Pennsylvania Health System were approached for referrals of relatives for a smoking cessation program, which involved behavioral counseling and nicotine patches. Primary outcomes were rate of program enrollment and rate of smoking abstinence. Potential mediators of smoking cessation were explored (e.g., treatment adherence, depression, anxiety). Two hundred and thirty-four relatives (113 cancer, 121 orthopedic) were considered eligible for the cessation program and comprised the study sample.

RESULTS

Relatives of oncology patients were significantly more likely to enroll in the smoking cessation program, vs. orthopedic relatives (75 % vs. 60%; OR = 1.96, 95% CI 1.07-3.61, p = .03), but they were not significantly more likely to remain in the program (61% vs. 52%) or quit smoking (19% vs. 26%; p's > .05). Compared to orthopedic relatives, oncology relatives showed significantly lower nicotine patch adherence and significantly greater levels of negative affect and depression and anxiety symptoms during treatment (p's < .05). Further, orthopedic relatives, compared to oncology relatives, showed a greater reduction in the perceived benefits of smoking (p = .06), which was significantly associated with abstinence (p = .02).

CONCLUSIONS

While a family member's cancer diagnosis may serve as a teachable moment for a smoker to enroll in a smoking cessation treatment program, high levels of psychological distress and perceptions of the benefits of smoking and low levels of treatment adherence may undermine successful abstinence among this population.