Lung cancer is now the leading cause of cancer death in both men and women in the U.S. In addition to primary prevention (tobacco control), secondary prevention through early detection with low-dose CT scans is recognized as a technique to identify earlier stage, more treatable lung cancers in high-risk patients. Evidence from the National Lung Screening Trial (NLST) showed that lung cancer screening with low-dose CT scans for high risk individuals (>30 pack years of smoking, <15 yr quit-time, and 55-74 yrs of age) conferred a 20% reduction in mortality for those patients who received 3 annual low dose CT scans. The U.S. Preventive Services Task Force (USPSTF) recently issued a final recommendation for annual screening for lung cancer in these high risk individuals, and many insurers now cover the screening. The present study is thus timely and novel ? we will investigate whether we can achieve higher rates of short- and long-term cessation in this high risk population. We will conduct a 2 x 2 (gain-framed intervention vs. unframed intervention, starter package of 2 weeks of nicotine patches and lozenges vs. no medication) study to evaluation methods to boost rates of smoking cessation for a high-risk group of smokers (N=616) with varying levels of motivation across 2 study sites (MUSC, Yale). Participants will be identified through the MUSC and Yale lung cancer screening programs at both sites. Randomization will be stratified by study site and level of motivation. The primary hypothesis is that rates of smoking cessation will be significantly higher at 6-months after lung screening for the smoking cessation strategy involving a gain-framed intervention + 2 weeks of nicotine patches and lozenges compared to a strategy of an unframed behavioral intervention + no medication. Our secondary hypothesis is that rates of smoking cessation will be higher for the gain-framed intervention group vs. the unframed intervention group and the starter package of 2 weeks of nicotine patches and lozenges group vs. the no medication group. On an exploratory basis we will also examine mediators and moderators of treatment. We hypothesize that changes in self-efficacy, smoking cessation outcome expectancy, familiarization with NRT, motivation, and autonomy will act as mechanisms for the smoking cessation effects (i.e., will act as mediators of treatment). We also hypothesize that lung screening findings (e.g., presence of a nodule, cancer, etc), nicotine dependence, and health disparities will modify treatment response (i.e., will act as baseline moderators of treatment). This project is designed to be translational (in that it can be transferable from our controlled efficacy study to other lung screening programs at other institutions) as all of our media will be digital files ready for sharing, the procedures for NRT sampling will be easily copied, and the print materials can be provided as fillable templates for personalization.

Public Health Relevance

The Center for Medicare and Medicaid Services (CMS) recently approved annual lung cancer screening as a benefit for individuals: (1) ages 55-77 years old; (2) asymptomatic (no signs of lung cancer illness); (3) tobacco smoking history of at least 30 pack-years; and (4) report current smoking or quit smoking within the past 15 years. While one might hypothesize that simply having a CT scan may promote cessation, evidence suggests that having a scan increases quit rates only slightly, if there is any increase at all. Most patients presenting for screening will have variable motivation to quit smoking, with many of them lacking motivation to quit. Studying smoking cessation interventions in the context of lung cancer screening has the potential to improve cessation rates for this high-risk group of smokers.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZCA1)
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Willis, Gordon B
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Medical University of South Carolina
Public Health & Prev Medicine
Schools of Medicine
United States
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Joseph, Anne M; Rothman, Alexander J; Almirall, Daniel et al. (2018) Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 197:172-182
Rojewski, Alana M; Tanner, Nichole T; Dai, Lin et al. (2018) Tobacco Dependence Predicts Higher Lung Cancer and Mortality Rates and Lower Rates of Smoking Cessation in the National Lung Screening Trial. Chest 154:110-118
Rojewski, Alana M; Zuromski, Kelly L; Toll, Benjamin A (2017) Strategies for smoking cessation among high risk populations to prevent lung cancer. Expert Rev Respir Med 11:85-87