Immediate, remote smoking cessation intervention in participants undergoing a targeted lung health check: QuLIT2 a randomised controlled trial

Abstract

BackgroundLung cancer screening programs provide an opportunity to support smokers to quit, but the most appropriate model for delivery remains to be determined. Immediate face to face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context is also effective.Materials and MethodsIn a single-blind randomised controlled trial, smokers aged 55-75 years attending a Targeted Lung Health Check (TLHC) were allocated by day of attendance to receive either immediate telephone smoking cessation support (TSI) (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy, or usual care (very brief advice to quit and signposting to smoking cessation services) (UC). The primary outcome was self-reported 7-day point prevalence smoking abstinence at three months. Differences between groups were assessed using logistic regression.Results315 current smokers taking part in the screening programme, mean (SD) age 63(5.4) years, 48% female, were randomised to telephone smoking cessation (n=152) or usual care (n=163). The two groups were well-matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (odds ratio [OR]: 2.83, 95% CI 1.44-5.61, p=0.002). Controlling for participant demographics, baseline smoking characteristics or the discovery of abnormalities on low dose CT scanning did not modify the effect of the intervention.ConclusionImmediate provision of an intensive telephone-based smoking cessation intervention, delivered within a targeted lung screening context, is associated with increased smoking abstinence at three months.Trial registrationThis study is registered online: ISRCTN12455871.Take home messageProviding immediate, telephone smoking cessation support with pharmacotherapy to smokers enrolled in a TLHC program increases quit rates in this population by almost a third.

Opportunistic Non-Governmental Organisation Delivery of a Virtual Stop Smoking Service in England during the COVID-19 Lockdown

“…A 2019 systematic review found moderate-certainty evidence that proactive telephone counselling helps smokers to quit smoking, but insufficient evidence to assess whether telephone counselling provided as an adjunct to other smoking cessation therapies has any additional effect [9]. There are promising signs that remote cessation services operated with some success in the pandemic; for example, studies required to change interventions from faceto-face behavioural support to remote behavioural support due to the pandemic found that quit rates [10] and clinic visits [11] for those in the intervention arm were similar for face-to-face and remote delivery. In Canada, it was found that the move to phone-based care for smoking cessation for cancer patients during the COVID-19 pandemic sometimes decreased counselling interruptions and improved follow-up rates [7].…”

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

“…Ten studies were RCT (32–41) and 3 used an observational study with control group design (33, 42, 43) (Table 1). The studies were published between 2004 and 2022, involved a total of 5076 people who smoked, with sample sizes ranging from 18 to 1248.…”

“…Studies investigated effectiveness of smoking cessation interventions as follows: single, in clinic session of behavioural counselling (44), single, in clinic session of behavioural counselling and audio materials (36), single in clinic behavioural counselling, plus NRT and subsequent weekly telephone calls (34), internet self-help materials (33), tailored information leaflet (40), 2 behavioural support calls and Quitline (42), multiple weekly behavioural support calls (37, 39), multiple weekly behavioural support calls and pharmacotherapy, (38, 41), multiple weekly behavioural support, in clinic plus pharmacotherapy (32, 43) or e-cigarettes (35). Timing of the intervention delivery varied across included studies from immediately on the day of the screening clinic to 5 months after screening, average length of interventions was 13.2±13.6 weeks.…”

“…To analyse the effectiveness of smoking cessation interventions, we performed a metaanalysis on included RCT which compared quit rate between smoking cessation and usual care groups delivered in a screening context. Meta-analysis of 8 RCTs eligible for inclusion (32,33,(35)(36)(37)(38)(39)41) (n= 1,984) demonstrated that providing a smoking cessation intervention improved quit rates among current smokers enrolled in screening programmes compared with usual care (OR: 2.01, 95%: 1.49-2.72 p<0.001), Figure 2. We included data from Arm 1 (e-cigarette with nicotine) and Arm 3 (usual care) from the Lucchiari et al, (35) study, as this best answered the research question.…”

“…The impact of smoking cessation interventions on the number of participants reporting quit attempts could be compared in 3 RCTs. (32,33,41)…”