Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration

Abstract

BACKGROUND: Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. OBJECTIVE: To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key ResultsOf the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. CONCLUSIONS:One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.

Optimizing Longitudinal Tobacco Cessation Treatment in Lung Cancer Screening

“…In 2 other SCALE trials, Foley et al reported 7-day abstinence rates of 13% at 6 months, and Tremblay et al reported 30-day abstinence rates of 13% to 14%. Clinical observational studies have reported quit rates in the LCS setting of 9% to 14% . Modeling studies support that integrating tobacco treatment with LCS yields cost-benefits of similar magnitude of LCS itself; for example, adding a tobacco cessation intervention with an effectiveness of 15% results in equivalent life-years gained as increasing LCS uptake from 30% to 100% .…”

“…Clinical observational studies have reported quit rates in the LCS setting of 9% to 14%. [33][34][35] Modeling studies support that integrating tobacco treatment with LCS yields cost-benefits of similar magnitude of LCS itself; for example, adding a tobacco cessation intervention with an effectiveness of 15% results in equivalent life-years gained as increasing LCS uptake from 30% to 100%. 36 The quit rates observed in PLUTO suggest that the investment of resources to adopt a chronic care model in the LCS setting would be effective and cost-effective.…”

Developing a pan-European technical standard for a comprehensive high-quality lung cancer computed tomography screening programme: an ERS technical standard

“…Trials that measured smoking cessation all concluded that the smoking cessation rates were above that observed in the general population [177][178][179][180][181]. The optimal strategy for integrating smoking cessation has been the focus of much research [15,174,179,[182][183][184][185][186][187][188][189][190][191][192][193][194]. There are limited data around provision of other services, such as psychological support, within the screening programme.…”

Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice

“…A recent study in the VA found high rates of screening among patients undergoing LCS. However, 82% of those identified as tobacco users received neither counseling nor pharmacotherapy, and only 1% of smokers receiving the recommended, most effective form of treatment: behavioral treatment plus pharmacotherapy [ 19 ]. Given the CMS policy change, it is now even more important to build commitment and capacity among LCS programs to implement TUT in their settings.…”