The Relations between False Positive and Negative Screens and Smoking Cessation and Relapse in the National Lung Cancer Screening Trial: Implications for Public Health

Clark, Melissa A.; Gorelick, Jeremy; Sicks, Jo Rean D.; Park, Elyse R.; Graham, Amanda L.; Abrams, David B.; Gareen, Ilana F.

doi:10.1093/ntr/ntv037

Cited by 35 publications

(49 citation statements)

References 34 publications

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“…The proportion of recent quitters that relapsed the year following a positive screen was 40.8 % (n=120) compared with 10.8 % (n=37) in subjects with a second positive scan (P<0.001). Among longer-term quitters there was no relation with positive screen results and relapse (16,17).…”

Section: Predictors For Smoking Abstinence In Lung Cancer Screening Tmentioning

confidence: 80%

“…These studies are systematically reviewed recently (15). In the Mayo study with 1,475 smokers and ex-smokers the 1-year quit rate was 12.1% (127/1,051) and the relapse rate was 6.6% (58/874) in exsmokers (16). In the PLuSS study with 3,642 smokers and ex-smokers the 1-year quit rate was 15.5% (325/2,094) with no data about relapsers (15).…”

Section: Non-randomised Trialsmentioning

confidence: 99%

“…Recent data from a subgroup of the NLST in 3,336 quitters and continued smokers (20) reported that primary care providers with respect to smoking cessation support only partially followed the 5As recommendations [i.e., ask about smoking (77%), advise to quit (76%), assess smoking status (63%), assist (56%) and arrange follow-up (10%)]. There was no effect on smoking abstinence from "ask", "advise" and "assess" but "assist" increased odds of quitting with 40% and "arrange follow-up" increased odds of quitting with 46% (16). Thus, clinicians should intervene more actively in smoking cessation in the future screening trials especially with focus on assisting smokers to quit (talking about quitting and recommend smoking cessation drugs and/or counseling) and arrange follow-ups.…”

Section: Predictors For Smoking Abstinence In Lung Cancer Screening Tmentioning

confidence: 99%

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Smoking cessation and lung cancer screening

2016

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Smoking behavior may have a substantial influence on the overall effect of lung cancer screening. Non-randomized studies of smoking behavior during screening have indicated that computer tomography (CT) screening induces smoking cessation. Randomized studies have further elaborated that this effect has to do with participation in screening alone and not dependent on the CT scan. Participants in both CT and control arm in randomized screening trials had higher smoking abstinence rate compared to that of the general population. A positive screening test seems to further promote smoking cessation and decrease smoking relapse rate. Also low smoking dependency and high motivation to quit smoking at baseline predicted smoking abstinence in screening trials. Lung cancer screening therefore seems to be a teachable moment for smoking cessation. Targeted smoking cessation counselling should be an integrated part of future lung cancer screening trials.

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Section: Predictors For Smoking Abstinence In Lung Cancer Screening Tmentioning

confidence: 80%

Section: Non-randomised Trialsmentioning

confidence: 99%

Section: Predictors For Smoking Abstinence In Lung Cancer Screening Tmentioning

confidence: 99%

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Smoking cessation and lung cancer screening

2016

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“…In the NLST, 7-day point prevalence quit rates (affirmative responses to the question, “Do you now smoke cigarettes [one or more cigarettes per week]?”) reported annually for 5 years after enrollment ranged from 11.6% to 13.4%. 15 …”

mentioning

confidence: 99%

Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial

et al. 2015

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Trial (NLST) found a reduction in lung cancer mortality among participants screened with low-dose computed tomography vs chest radiography. In February 2015, Medicare announced its decision to cover annual lung screening for patients with a significant smoking history. These guidelines promote smoking cessation treatment as an adjunct to screening, but the frequency and effectiveness of clinician-delivered smoking cessation interventions delivered after lung screening are unknown.OBJECTIVE To determine the association between the reported clinician-delivered 5As (ask, advise, assess, assist [talk about quitting or recommend stop-smoking medications or recommend counseling], and arrange follow-up) after lung screening and smoking behavior changes. DESIGN, SETTING, AND PARTICIPANTSA matched case-control study (cases were quitters and controls were continued smokers) of 3336 NLST participants who were smokers at enrollment examined participants' rates and patterns of 5A delivery after a lung screen and reported smoking cessation behaviors. MAIN OUTCOMES AND MEASURESPrevalence of the clinician-delivered 5As and associated smoking cessation after lung screening.RESULTS Delivery of the 5As 1 year after screening were as follows: ask, 77.2%; advise, 75.6%; assess, 63.4%; assist, 56.4%; and arrange follow-up, 10.4%. Receipt of ask, advise, and assess was not significantly associated with quitting in multivariate models that adjusted for sociodemographic characteristics, medical history, screening results, nicotine dependence, and motivation to quit. Assist was associated with a 40% increase in the odds of quitting (odds ratio, 1.40; 95% CI, 1.21-1.63), and arrange was associated with a 46% increase in the odds of quitting (odds ratio, 1.46; 95% CI, 1.19-1.79). CONCLUSIONS AND RELEVANCEAssist and arrange follow-up delivered by primary care providers to smokers who were participating in the NLST were associated with increased quitting; less intensive interventions (ask, advise, and assess) were not. However, rates of assist and arrange follow-up were relatively low. Our findings confirm the need for and benefit of clinicians taking more active intervention steps in helping patients who undergo screening to quit smoking.

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“…More than a third of our respondents (38%) reported that they quit smoking following the identification of a pulmonary nodule, though how each individual defined smoking cessation or whether this benefit persisted is unknown. This suggests that nodule detection may represent a “teachable moment” with regard to smoking cessation and is consistent with the finding that patients with a screen-detected nodule are more likely to quit smoking than those with a normal screening CT. 42–45 …”

Section: Discussionmentioning

confidence: 99%

Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

Freiman

Clark

Slatore

et al. 2016

Journal of Thoracic Oncology

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Introduction Pulmonary nodules are detected in over a million Americans each year. Prior qualitative work suggests the detection of incidental pulmonary nodules can be burdensome for patients, but it is unknown whether these findings generalize to a broader sample of patients. We categorized patients’ knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, and their impressions of clinician communication. Methods We administered a cross-sectional survey to adults with an incidental pulmonary nodule recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital. Results Of 490 surveys mailed, 244 (50%) responded. Median nodule size was 7 mm; mean patient age was 67 years; 29% were female, and 86% were white. A quarter (26%) of respondents reported clinically significant distress related to their nodule as measured by the Impact of Event scale, our primary outcome. Patients reported multiple concerns including uncertainty about the nodule’s etiology (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall there was no correlation between perceived and actual risk (r=−0.007, p=0.93). Among the 23% of patients who did receive cancer risk information from their provider, they were more likely to find this information reassuring (16%) than scary (7%). Conclusion A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.

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The Relations between False Positive and Negative Screens and Smoking Cessation and Relapse in the National Lung Cancer Screening Trial: Implications for Public Health

Cited by 35 publications

References 34 publications

Smoking cessation and lung cancer screening

Smoking cessation and lung cancer screening

Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial

Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

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