Few Lung Screening Trial Participants Who Smoke Get Cessation Pharmacotherapy

Pharmacologic smoking cessation therapy is associated with an increased likelihood of quit attempts, although most individuals who smoke and had lung cancer screening did not receive this therapy, according to a study in Chest.

Investigators conducted a secondary analysis of National Lung Screening Trial (NLST) data, examining a subset of individuals who smoked to determine which patient and treatment factors were associated with the individual’s likelihood to attempt to quit smoking. The analysis included patients who were enrolled from August 2002 through April 2004 and were followed until December 2009. Participants completed detailed smoking questionnaires at 6-month intervals.

The primary clinical outcome was the percentage of individuals who attempted to quit smoking. Investigators measured quit attempts, which were self-reported by participants and considered valid when individuals indicated they had not smoked within the past 6 months.

The investigators analyzed the association of multiple variables — including patient demographics, smoking behaviors, tobacco treatment variables — with an individual’s smoking status, which was defined as either “quit attempter,” meaning an individual who attempted to quit, or “stable user,” meaning an individual who did not report any cessation in smoking in their questionnaire responses.

The analysis included 4380 individuals categorized as “stable users” (mean age at randomization, 61.0 years; 47.8% female) and 2989 individuals categorized as “quit attempters” (mean age at randomization, 61.0 years; 43.8% female). Those who did not attempt to quit were more likely to be women (P <.001), unmarried (43.2% vs 36.9%, P <.001), Black (8.2% vs 6.3%, P =.007), and have less than a college education (47.7% vs 42.3%, P <.001).

Those who had attempted to quit had a lower mean pack-year smoking history (53.3 pack-years vs 56.0 pack-years, P <.001) and were more likely to have low nicotine dependence (13.7% vs 9.2%, P <.001) compared with those who did not attempt to quit (ie, “stable users”).

Regarding pharmacologic tobacco treatment, 73.3% of participants reported that they did not receive any, 14.7% received NRT, 7.3% received bupropion, and 4.6% received NRT and bupropion. Those who attempted to quit were more likely to report receiving pharmacologic treatment compared with those who did not (18.0% vs 12.4%, P <.001 for NRT; 8.0% vs 6.9%, P =.0162 for bupropion; and 5.6% vs 3.9%, P <.001 for both NRT and bupropion).

Patients who were diagnosed with lung cancer during the study were 75% more likely to attempt quitting if they had low to medium dependence and 92% more likely to attempt to quit if they had high to very high dependence.

Individuals who had a high and very high dependence and received pharmacologic therapy were 1.7 to 2 times more likely to have a quit attempt vs those with no treatment. The strongest association was found in individuals who received both bupropion and NRT (bupropion, hazard ratio [HR] 1.72 [95% CI, 1.49-1.98]; NRT, HR 1.87 [95% CI, 1.68-2.09]; and both treatments, HR 2.07 [95% CI, 1.75-2.44]).

Study limitations include inability to determine causation due to the study design; the use of self-reported data; lack of confirmation of smoking abstinence through biologic testing; and selection bias (because those participating in the NLST may have had more motivation to quit than the general public).

“Pharmacologic treatment should be offered to all patients who smoke during lung cancer screening, and additional study is needed to help tailor effective pharmacologic treatment and further elucidate barriers to smoking cessation for specific populations,” the investigators stated.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.