Optimizing Longitudinal Tobacco Cessation Treatment in Lung Cancer Screening: A Sequential, Multiple Assignment,...

Area of Science:

• Pulmonology
• Oncology
• Addiction Medicine

Background:

• Lung cancer screening (LCS) eligibility includes nearly half of US adults who smoke.
• Optimal smoking cessation program components within LCS settings remain unclear.
• Effective interventions are needed to support smoking cessation in this high-risk population.

Purpose of the Study:

• To evaluate the impact of adding medication therapy management (MTM) to tobacco longitudinal care (TLC) for LCS-eligible smokers who do not respond to early tobacco treatment.
• To assess the effect of reducing TLC intensity (quarterly contact) for LCS-eligible smokers who do respond to early treatment.

Main Methods:

• A randomized clinical trial involving daily cigarette smokers eligible for LCS.
• Participants were recruited from primary care and LCS programs across three large US health systems.
• Interventions included intensive TLC, TLC with MTM referral, and reduced-intensity Quarterly TLC, assigned based on early treatment response.

Main Results:

• Overall 6-month prolonged smoking abstinence at 18 months was 24.4%.
• Adding MTM to TLC for early non-responders did not significantly improve abstinence rates (17.8% vs. 16.4%).
• Reducing TLC intensity for early responders did not improve abstinence (43.6% vs. 58.6%).

Conclusions:

• Referral to MTM alongside TLC does not enhance smoking abstinence in non-responders within the LCS setting.
• Decreasing TLC intensity for early responders is not recommended.
• Integrating longitudinal tobacco cessation care with LCS is feasible and yields clinically meaningful quit rates.