Missed opportunities for tobacco dependence treatment among U.S. veterans referred for lung Cancer screening: An...

Tobacco dependence treatment (TDT) should be offered to all lung cancer screening (LCS) participants who smoke. We sought to examine the provision of TDT among patients referred for LCS.

We performed a multi-center, retrospective observational analysis of patients referred for LCS at seven regionally-affiliated Veterans Affairs Medical Centers and associated clinics from 9/2022-9/2023. We identified LCS referrals and tobacco use using administrative data. We extracted TDTs (±45 days from referral or Low-dose computed tomography [LDCT]) including medications and tobacco-related visits (TRVs). Outcomes included any pharmacotherapy, any TRV, and combined TDT (pharmacotherapy + two or more TRVs). Results were analyzed using generalized linear mixed effects models.

9319 patients were referred for LCS, of whom 58.6 % currently smoked. Of those, 47.9 % resided in rural areas, 6.9 % were Black, 6.7 % were female; mean age was 67.7. Among those who currently smoked, 17.4 % received any pharmacotherapy, 13.6 % had at least one TRV, and 6.4 % had combined TDT. Participants in the LCS program were significantly more likely to receive medications around the time of the initial LDCT, with odds ratios (OR) < 1 for all comparison groups: interval scan OR 0.60 (95 %CI 0.48,0.76) no scan OR 0.65 (95 %CI 0.52,0.83), subsequent annual scan OR 0.59 (95 %CI 0.46,0.75). This pattern held for all three outcomes. Rural-residing individuals were less likely to have a TRV or receive combined TDT.

We found low rates of TDT and a concerning drop off in treatment after initial LDCT. Failure to address tobacco throughout the longitudinal process represents a missed opportunity.

Veterans Affairs Quality Enhancement Research Institute (PII I50 HX003692-01) and a Health Systems Research Career Development Award (CDA 19-180).