An Optimization Randomized Clinical Trial to Identify an Effective, Efficient Smoking Cessation Intervention in the...

Approximately 50% of the estimated 14 million people eligible for lung cancer screening (LCS) currently smoke. Gaps in knowledge regarding optimal tobacco treatment interventions in the context of LCS remain.

What is the most value-efficient, evidence-based combination of tobacco treatment component(s) for people seeking LCS who smoke?

Cessation and Screening to Save Lives (CASTL) is an optimization randomized clinical trial conducted at 17 LCS sites in the US. Eligible participants 50 to 80 years of age, scheduled for LCS, and currently smoking were randomized to 1 of 16 combinations of tobacco treatment components: enhanced standard care, motivational interviewing, nicotine patch/lozenge, and message framing. The primary outcome was self-reported abstinence at 6-month follow-up. The cost of each combination of components was estimated as a function of time and resources.

Of the 758 participants at enrollment, about 5% of participants were not interested in quitting, 59% were considering quitting, and 38% already were making changes in their smoking. Most (79%) reported smoking within 30 minutes of waking, indicating a high nicotine dependence. Although there were no significant differences among the intervention components, the most value-efficient intervention with respect to expected abstinence was loss-framed messaging, nicotine patch, and lozenge (expected abstinence rate, 30%; mean cost, $287.41). Among the less-costly combinations, a value-efficient alternative included gain-framed messaging only (abstinence, 13%; cost, $51.29).

Our results show that LCS provides a compelling opportunity to provide evidence-based tobacco treatment to individuals at risk for lung cancer. Integrating combination nicotine replacement therapy and brief communication about the harms of smoking is a promising value-efficient, feasible option for improving cessation outcomes. Future trials should evaluate the effectiveness implementation of this promising package and examine scalable strategies for implementation of tobacco use treatment in LCS settings.

ClinicalTrials.gov; No.: 03315910; URL: www.

gov.