Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial

Abstract

ObjectivesLung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screening programme, increases quit rates compared to usual care (Very Brief Advice to quit and signposting to smoking cessation services).Materials and methodsWe conducted a single-blind randomised controlled trial of current smokers aged 55–75 years attending a Targeted Lung Health Check. On randomly allocated days smokers received either (1) immediate support from a trained smoking cessation counsellor with appropriate pharmacotherapy or (2) usual care. The primary outcome was self-reported quit rate at 3 months. We performed thematic analysis of participant interview responses.ResultsOf 412 people attending between January and March 2020, 115 (27.9%) were current smokers; 46% female, mean (SD) 62.4 (5.3) years. Follow-up data were available for 84 smokers. At 3 months, quit rates in the intervention group were higher 14/48 (29.2%) vs 4/36 (11%) (χ2 3.98, p=0.04). Participant interviews revealed four smoking-cessation related themes: (1) stress and anxiety, (2) impact of the COVID-19 pandemic, (3) CT scans influencing desire to quit and (4) individual beliefs about stopping smoking.ConclusionThe provision of immediate smoking cessation support is associated with a substantial increase in quit rates at 3 months. Further research is needed to investigate longer-term outcomes and to refine future service delivery.Trial registration numberISRCTN12455871.

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

“…Our results support the hypothesis that the immediate provision of remote, intensive smoking cessation support for high-risk people who smoke undergoing TLHC, is more effective (21.1% vs 8.9%) for increasing quit rates within this cohort than usual care. These findings extend those from our previous trial QuLIT-1, which found immediate face-to-face support can increase quit rates compared to usual care (29.2% vs 11%) in the context of TLHC (15). Comparing the two trials, the quit rates in the usual care groups in both studies were numerically similar whereas quit rates in the face-to-face intervention were higher.…”

“…Several trials, including our initial QuLIT-1 study have investigated the impact of smoking cessation support within lung cancer screening pathways (11, 12, 14, 15, 23) The 21.1% three-month quit rate observed in the QuLIT-2 intervention arm is comparable with other studies where quit rates ranged from 10-25%. Interestingly, the two studies which reported lower interventional quit rates than our current study conducted their cessation remotely (telephone and online) and did not offer any pharmacotherapy (11, 23).…”

“…QuLIT-2 was a single-blind, randomised, controlled trial comparing the effectiveness of an immediate, intensive telephone smoking cessation intervention (TSI) compared to Very Brief Advice (VBA) and signposting delivered in the context of a TLHC. People living in the London boroughs of Sutton, Hillingdon, and Hammersmith and Fulham, aged 55-75, with a recorded history of smoking, were invited for a TLHC assessment as described previously (15). All current smokers who took part in the TLHC were included in the study (current smokers were defined as any person self-reporting smoking tobacco including cigarettes, pipes and cigars at the time of the TLHC).…”

“…In the initial phase of the Quit Smoking Lung Intervention Trial (QuLIT-1) we demonstrated a significant increase in 3 month quit rate (29.9% vs 11%), for TLHC participants randomised to receive immediate face to face cessation support and pharmacotherapy, compared to usual care (UC). The latter consisted of very brief advice to quit (VBA) and signposting to smoking cessation support (15). Because of the COVID-19 pandemic, face to face support was suspended in March 2020 and the study was modified to investigate, in a discrete second phase (QuLIT-2), whether remote delivery of the smoking cessation intervention was also effective compared to usual care.…”

Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend

“…Indeed, attendees within the Italian lung screening trial (ITALUNG) receiving screening at a centre with integrated smoking cessation had greater odds of cessation compared to attendees at other screening centres 62 . Additionally, a trial in England has shown that the provision of immediate smoking cessation within a TLHC is associated with an increase in quit rates at a 3‐month follow‐up 63 . Integrating cessation interventions within the screening appointment and disclosure of screening results may increase cessation uptake by ensuring accessibility of the service, providing readily available treatment, and preventing referral‐related disengagement.…”