Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Randomized Clinical Trial
Mené aux Etats-Unis auprès de 630 participants à un programme de dépistage du cancer du poumon (âge médian : 59 ans), cet essai randomisé évalue l'efficacité, du point de vue du taux d'abstinence tabagique à 6 mois vérifiée biochimiquement, de trois stratégies de sevrage : ligne d'aide à l'arrêt du tabac et traitements substitutifs nicotiniques (TSN), ligne d'aide à l'arrêt du tabac et TSN ou médication prescrite par un clinicien du programme de dépistage, soins intégrés comprenant un TSN ou prescription d'un traitement et conseils
Importance : The optimal configuration of a smoking cessation intervention in a lung cancer screening (LCS) setting has not yet been established.
Objective : To evaluate the efficacy of 3 tobacco treatment strategies of increasing integration and intensity in the LCS setting.
Design, Setting, and Participants : In this randomized clinical trial, LCS-eligible current smokers were randomized into 3 treatments: quitline (QL), QL plus (QL+), or integrated care (IC). The study was conducted from July 2017 to June 2022 at a hospital-based tobacco treatment clinic in Houston, Texas.
Interventions : The QL intervention group had quitline referral and 12-week nicotine replacement therapy (NRT). The QL+ group had quitline referral plus 12-week NRT or pharmacotherapy prescribed by the LCS clinician. The IC group had 12-week NRT or prescription pharmacotherapy and counseling provided by tobacco treatment specialists within the LCS health care environment.
Main Outcomes and Measures : The original primary outcome was biochemically verified 7-day point prevalence abstinence at 6 months; however, this was changed to self-reported abstinence during the conduct of the study due to COVID-19 pandemic restrictions.
Results : Of 630 participants, 320 (50.8%) were male, and the median (IQR) age was 59 (55-64) years. Participants smoked a median (IQR) of 20 (15-25) cigarettes per day. Each cohort (QL, QL+, and IC) was composed of 210 participants. The median (IQR) number of counseling sessions was 4 (2-5) sessions for both QL and QL+ and 8 (7-9) sessions for IC. At 3 months, 53 participants (25.2%) in QL, 57 (27.1%) in QL+, and 78 (37.1%) in IC reported abstinence. IC outperformed both QL (odds ratio [OR], 1.75 [95% CI, 1.15-2.66]; P = .01) and QL+ (OR, 1.58 [95% CI, 1.05-2.40]; P = .03). At 6 months, IC maintained the highest rate of abstinence with 68 individuals (32.4%), followed by QL+ at 58 (27.6%) and QL at 43 (20.5%). IC outperformed QL at this time point (OR, 1.86 [95% CI, 1.19-2.89]; P = .01). In the bayesian analysis, IC demonstrated a higher probability of positive absolute risk differences (ARDs) in abstinence at 3 months vs QL (ARD, 0.12) with 99% probability of positive ARD, and QL+ (ARD, 0.10) with 98% probability of positive ARD. This advantage was maintained at 6 months with ARDs of 0.12 for QL (probability of positive ARD, 99%) and 0.05 for QL+ (probability of positive ARD, 86%).
Conclusions and Relevance : In this randomized clinical trial, IC involving medication and intensive counseling provides the best opportunity for smoking cessation relative to QL counseling, with or without LCS clinician–managed medication. Although IC consistently outperformed QL and QL+, differences with QL+ were reduced at 6 months, suggesting QL+ could be considered in low-resource settings.
JAMA Internal Medicine , article en libre accès, 2024