Personalised smoking cessation support in a lung cancer screening programme

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Published: 11 Aug 2022
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Dr Rachael Murray - The University of Nottingham, Nottingham, UK

Dr Rachael Murray provides an overview of the Yorkshire Enhanced Stop Smoking Study (YESS).

Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost-effectiveness.

The most effective way to use this 'teachable moment' is unclear.

Unless explicitly declined, all smokers enrolled in the Yorkshire Lung Screening Trial (YLST) will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette.

At 4 weeks, if participants had ceased smoking, carbon monoxide validation was used to validate they had quit and participants were offered enrolment into the YESS study.

The YESS study is a double-blind randomised controlled trial of an enhanced, personalised smoking cessation support package including a booklet containing CT images of the participants’ own heart and lungs, annotated where appropriate to highlight emphysema or coronary artery calcification (CAC) with accompanying explanatory text and scripted behavioural support delivered by a trained smoking cessation practitioner SCP, compared to continued standard best practice.

Participants were followed-up at 3- and 12-months, collecting smoking status, psychological change variables, quality of life and health care usage.

Our study is the Yorkshire Enhanced Stop Smoking study, or YESS as I’ll call it from now on. We’re a Yorkshire Cancer Research funded study which is looking at the effect of adding a co-located and a personalised stop smoking intervention to a lung cancer screening programme.

What was the methodology behind this study?

There are two parts to it. In the first part we wanted to get stop smoking support to every smoker that was attending for lung cancer screening. So everyone that attended was offered an opt-out on-site consultation at the point they came for their lung health check. Everybody got the same intervention, so that was a one-to-one behavioural counselling session, provided nicotine replacement therapies and/or e-cigarettes and vaping supplies or, if they wanted, we would refer to the GP for prescription medications. 

So we provided that to everybody for the first four weeks and then at the four-week follow-up point we collected smoking status in everybody and we used a carbon monoxide validation for people that said they had quit. Then our intervention group would receive all the exact same that they had already had plus our personalised intervention which consisted of using their heart and lung images that were captured during their LD CT scan and highlighting areas of coronary artery calcification and emphysema and to use that as part of our package of tools to support smoking cessation.

What were the key findings?

When we looked at the first four week provisions, so looking at everybody, the really interesting finding was that 89% of all the smokers that were eligible and attended for the lung cancer screening programme actually agreed to the first consultation with our stop smoking advisor, which is a really fantastic proportion. Of those people, 84% went on to accept longer term a smoking cessation treatment course. Of those that accepted the support we actually found a quit rate of 16.5% which was validated at the four week point. So these people had not smoked for seven days prior to that four week intervention period and that increased to 20% if we looked at self-reported figures. Likewise, if we looked at the entire population, so trying to look on a wider scale, our validated quit rates at the same time point was 12.1% which increased to 15% if we used self-reported figures. 

So our primary outcome was smoking status at three months after the lung health check and in our intervention arm we had a 33.6% quit rate and in our usual care arm we had a 30% quit rate. So there was no significant difference between those two groups but a quit rate of around 30% is really quite positive. When we looked at our twelve month quit rates those figures were largely maintained. So at twelve months we had quit rates of around 28-29%.

How could these results affect smoking cessation?

In terms of a co-located and opt-out delivery model the study has proved that it’s very efficacious to put this kind of service provision in place. Hopefully now that we’ve proved that it can work then the same model may be adopted by the UK and other countries that are looking at rolling out a lung cancer screening programme. 

With regards to the intervention, it didn’t seem to have had any difference between our two study arms but there was significant difference in gender in that we found our females had significantly higher quit rates than men who had received the intervention booklet. So there are a lot of questions that are still unanswered about do we need a gender specific intervention to support women or do we need to replicate the study in a bigger setting. We’re only one study in one region of the UK but overall there’s great promise for the future provision of stop smoking in lung cancer screening which is vitally important.