Effectiveness of National Residential Smoking Cessation Program

Effectiveness of residential versus outpatient therapy for smoking cessation: The START randomized clinical trial

BACKGROUND AND AIMS

Tobacco smoking represents a major cause for preventable death and morbidity. Results from non-randomized studies suggest that smoking cessation therapy in a residential setting might be a new viable way to facilitate smoking abstinence. We aimed to test the effects of residential multicomponent group therapy for smoking cessation compared with outpatient group therapy.

DESIGN

Prospective parallel-group open-label randomized superiority trial, with assessments at baseline, 6 and 12 months.

SETTING

Recruitment throughout Germany via media advertisements.

PARTICIPANTS

Adult smokers (≥10 cigarettes/day) randomly assigned to residential (n = 157) or outpatient (n = 158) therapy. 51.8% female; mean age 53.2 years; mean years of smoking 34.4.

INTERVENTION AND COMPARATOR

Residential 9-day smoking cessation group therapy comprising six daily therapy sessions and supportive interventions for cessation and daily structure embedded in the routines of a somatic rehabilitation center, compared with weekly outpatient smoking cessation group therapy (3-7 weeks) provided in routine care courses close to the participants' places of residence, both including at least 9 h of behavioral therapy.

MEASUREMENTS

Co-primary outcomes were self-reported continuous 6- and 12-month abstinence (hierarchically ordered). Primary analyses were conducted in the therapy-uptake population including participants who started therapy with sensitivity analyses in the intention-to-treat population of all randomized participants.

FINDINGS

Intervention uptake rates were 87.3% (n = 137) in the residential and 60.1% (n = 95) in the outpatient group. In the therapy-uptake population, abstinence rates were 46.7% in the residential versus 26.3% in the outpatient group at 6 months (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.39-4.33, P = 0.0019) and 39.4% versus 24.2% at 12 months (OR = 2.04, 95% CI = 1.14-3.64, P = 0.017). Biochemically validated abstinence rates at 12 months were 33.1% in the residential versus 17.4% in the outpatient group (OR = 2.35, 95% CI = 1.22-4.51, P = 0.011). In the intention-to-treat population, self-reported and biochemically validated abstinence rates at 12 months were 34.4% in the residential versus 14.6% in the outpatient group (OR = 3.08, 95% CI = 1.77-5.34, P < 0.0001) and 28.6% versus 10.3% (OR = 3.48, 95% CI = 1.85-6.52, P = 0.0001), respectively.

CONCLUSIONS

Residential therapy exclusively for smoking cessation is feasible and effective and could be a beneficial new treatment for smokers.

Residential Treatment Exclusively for Tobacco Use Disorder: A Narrative Review

INTRODUCTION

Tobacco use disorder is a major public health issue, and novel smoking cessation approaches are urgently needed. Residential treatment programs have been suggested as a potentially effective treatment for tobacco use disorder. However, there is limited literature on residential treatment programs for patients who are exclusively dependent on nicotine.

AIM

The aim of this study is to review the literature on residential treatment programs for patients admitted exclusively for tobacco use disorder.

METHODS

A literature search was conducted in PubMed with the aim of identifying relevant articles on residential treatment exclusively for tobacco use disorder from inception until February 2023. References in retrieved articles were screened for additional relevant articles.

RESULTS

Fourteen studies on residential treatment programs for tobacco use disorder were identified. The duration of the residential cessation programs ranged from 3 days to 3 weeks. Individualized or group cognitive behavioral therapy and tailored pharmacotherapy were the key components of the programs. Eligibility criteria for the programs included moderate to severe tobacco use disorder as measured by Fagerström or Diagnostic and Statistical Manual of Mental Disorders (DSM), consistent relapses, smoking-related comorbidities (eg, cardiovascular or pulmonary diseases), and daily use of (smokeless) tobacco. The 6- and 12-month 7-day point prevalence rate ranged from 58% to 26%, whereas the 6- and 12-month continuous abstinence rate ranged from 52% to 29%.

CONCLUSIONS

Based on the literature we reviewed, residential smoking cessation programs targeted exclusively at individuals with tobacco use disorder have shown effectiveness, particularly for those who are highly dependent on tobacco and have a history of relapse. However, more research is needed to further explore the effectiveness of these programs and to determine the optimal program components and duration.

Trends in Survival Rates of Non-Small Cell Lung Cancer With Use of Molecular Testing and Targeted Therapy in Korea, 2010-2020

IMPORTANCE

Over the past 10 years, treatment of non-small cell lung cancer (NSCLC) has been continually revolutionized. However, standard clinical trials may not reflect current multiple lines of treatment and corresponding outcomes in a timely manner.

OBJECTIVE

To investigate outcomes associated with new treatment of NSCLC in a clinical setting.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included patients with NSCLC between January 1, 2010, and November 30, 2020, who received any anticancer treatment at Samsung Medical Center in Korea. Data were analyzed from November 2021 through February 2022.

EXPOSURES

Clinical and pathological stage, histology, and major druggable sequence variation, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS1, RET, MET exon 14 skipping, BRAF V600E, KRAS G12C, and NTRK between 2 periods (period I: 2010-2015 vs period II: 2016-2020).

MAIN OUTCOMES AND MEASURES

The primary outcome was the 3-year survival rate of NSCLC. Secondary outcomes included median overall survival, progression-free survival, and recurrence-free survival.

RESULTS

Among 21 978 patients with NSCLC (median [range] age at diagnosis, 64.1 [57.0-71.0] years; 13 624 males [62.0%]), there were 10 110 patients in period I and 11 868 patients in period II; adenocarcinoma (AD) was the predominant histology (7112 patients [70.3%] in period I and 8813 patients [74.3%] in period II). There were 4224 never smokers [41.8%] in period I and 5292 never smokers [44.6%] in period II. Compared with patients in period I, patients during period II were more likely to undergo molecular tests in the AD (5678 patients [79.8%] vs 8631 patients [97.9%]) and non-AD (1612 of 2998 patients [53.8%] and 2719 of 3055 patients [89.0%]) groups. In patients with AD in period I, 3-year survival rates were 92.8% (95% CI, 91.8%-93.7%), 72.4% (95% CI, 68.3%-76.8%), 56.7% (95% CI, 53.4%-60.2%), and 28.7% (95% CI, 27.0%-30.4%) for stage I, II, III, and IV, respectively. In period II, 3-year survival rates of patients with AD were 95.1% (95% CI, 94.4%-95.9%), 82.5% (95% CI, 79.1%-86.1%), 65.1% (95% CI, 61.8%-68.6%), and 42.4% (95% CI, 40.3%-44.7%) for each stage, respectively. In patients without AD, 3-year survival rates were 72.0% (95% CI, 68.8%-75.3%), 60.0% (95% CI, 56.2%-64.1%), 38.9% (95% CI, 35.6%-42.5%), and 9.7% (95% CI, 7.9%-12.1%) for each stage in period I. In period II, the 3-year survival rates of patients without AD were 79.3% (95% CI, 76.3%-82.4%), 67.3% (95% CI, 62.8%-72.1%), 48.2% (95% CI, 44.5%-52.3%), and 18.1% (95% CI, 15.1%-21.6%) for each stage.

CONCLUSIONS AND RELEVANCE

In this cohort study of 10 years of clinical data, survival outcomes were improved across all stages, with larger increases in patients with stage III to IV disease. The incidence of never-smokers and the use of molecular testing increased.

Association between Low-Dose Computed Tomography Results and 1-Year Smoking Cessation in a Residential Smoking Cessation Program

The COVID-19 pandemic is a global health threat. Smoking and smoking-related lung diseases are risk factors for severe COVID-19 infection. This study investigated whether low-dose computed tomography (LDCT) scan results affected the success of 1-year smoking cessation. The Gyeonggi Southern Smoking Support Center performed the residential smoking cessation program from January to December 2018. During the program, LDCT was performed on 292 participants; 6 months later, follow-up via telephone or visit was conducted. Among the 179 participants who succeeded in smoking cessation for 6 months, telephone follow-up was conducted to determine whether there was a 12-month continuous smoking cessation. In order to evaluate the association between LDCT results and 12-month continuous abstinence rate (CAR), logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). The CARs at 6 and 12 months were 61.3% and 31.5%, respectively. Indeterminate or suspicious malignant lung nodules were associated with a higher 12-month CAR (OR, 3.02; 95% CI, 1.15–7.98), whereas psychiatric history was associated with a lower 12-month CAR (OR, 0.06; 95% CI, 0.03–0.15). These results suggest that abnormal lung screening results may encourage smokers to quit smoking.

Stationäre Behandlung exklusiv zur Raucherentwöhnung – Konzept einer intensivierten verhaltenstherapeutischen Gruppentherapie

Zielsetzung Angesichts hoher Morbidität und Mortalität durch Tabakabhängigkeit besteht ein dringender Bedarf an effektiven Angeboten zur Raucherentwöhnung. Die leitliniengemäß durchgeführten ambulanten Therapien sind in ihrer langfristigen Wirksamkeit jedoch limitiert. Im Folgenden wird ein erstmalig in Deutschland entwickeltes wissenschaftliches stationäres Therapiekonzept ausschließlich zur stationären Raucherentwöhnung beschrieben und die Evidenz für die langfristige Effektivität dieser intensivierten Therapieform zur Raucherentwöhnung diskutiert.

Methodik Es handelt es sich um ein multimodales neuntägiges verhaltenstherapeutisches Therapiekonzept für den stationären Einsatz. Die Entwöhnung wird als Gruppentherapie leitliniengemäß von einem mobil einsetzbaren Team geschulter Raucherentwöhner:innen durchgeführt, ergänzt durch Angebote zur Förderung der Gruppenkohäsion, Tagesstrukturierung, zum Bewegungstraining, Ernährungsmanagement, Ressourcenaufbau, Expositionstraining rückfallkritischer Situationen und zur achtsamkeitsbasierten Stressbewältigung.

Schlussfolgerungen Eine stationäre Raucherentwöhnungstherapie ist als vielversprechende Ergänzung bzw. Alternative zur ambulanten Entwöhnung umsetzbar. Die intrinsische Abstinenzmotivation soll in einem geschützten Rahmen bei professioneller Betreuung und Unterstützung in der Gruppe gestärkt werden mit Fokus auf den Transfer der Kompetenzen in den Alltag. Erste Studienergebnisse weisen auf eine hohe langfristige Entwöhnungsquote hin. Eine wissenschaftliche Überprüfung der (Kosten-)Effektivität anhand randomisiert-kontrollierter Studien steht noch aus.