MTE22.01 Integration of Cessation and Lung Cancer Screening

Abstract

Lung cancer screening with low dose computed tomography (LDCT) has been studied extensively and is recommended for individuals who are deemed to be at increased risk, typically with a smoking history of 30 pack-years or more. The National Lung Screening Trial (NLST) demonstrated that with a screening program, there was a 20% reduction in lung cancer mortality. The overall incidence of lung cancer in the NLST was around 2%. Unfortunately, an often overlooked, yet treatable condition in any lung cancer screening program is continued tobacco use. In the NLST, 48% of participants were actively smoking at the time of the screening, and in our institutional program 71% are actively smoking. Cessation in this group may be seen as a challenge, as many of these patients have a much greater than 30 pack-year history and have not quit despite being advised by their primary physician. However, the lung cancer screening program may interact with the patient in a 'teachable moment' and these patients receiving screening may have increased motivation and willingness to quit if given the right resources. External resources such as quitlines or referrals to external tobacco cessation programs require action and increased motivation on the aprt of the patient, while integrating resources in the workflow of the screening program deliver the resources to the patient as a standard part of practice. Furthermore, the lung cancer screening program may be able to interact with the patient over time (through annual follow up at least) and may be an optimal way to deliver cessation resources to these patients. This session will explore different programmatic strategies to deliver cessation resources to patients in the construct of a LDCT Lung Cancer screening program. The coordinator of our screening program is a Advance Practice Registered Nurse (APRN) who sought out training and certification as a certified Tobacco Treatment Specialist (TTS). Referrals to the LDCT screening program are initially contacted by phone for a scheduling phone call, which also includes the initial elements of counseling these patients regarding tobacco cessation. An initial intake phone call determines appropriateness for screening and also can include elements of the 5A framework: ASK, ADVISE, ASSESS, ASSIST, ARRANGE. Then on the day of the scan, the APRN coordinator meets with the patient face-to-face at the point of the scan, and has already established rapport by telephone prior to the visit. The day of the scan, the patient receives in person counseling as part of their visit, and a cessation strategy or "Quit Plan” is made which may include medications such as nicotine patches and/or gum. After the scan, telephone follow up is conducted to both discuss cessation and discuss scan results with a plan for follow up. Additionally, patients can be enrolled in a state Quitline program as a standard part of the workflow which provides them with ongoing support. Another option for patients is for the screening program to refer them to group counseling sessions. The American Lung Association's Freedom From Smoking is one such structured program. Patients may not independently seek these programs out, but as a lung screening program, developing ties to programs in the community with integrated referrals to group counseling programs can be another way to further the delivery of resources to these patients. As patients return for repeat scans to follow up indeterminate nodules, or return the following year for routine scans, further cessation support is delivered, and if they have quit, abstinence support is provided. Quitlines, group counseling, and nicotine replacement therapy have been shown to be cost effective strategies to help people who smoke to increase chances of quitting. A lung screening program may identify 2% of its participants with lung cancer, but if half (or in our case 71%) are smoking, and integrated cessation resources help those patients to reduce or quit smoking, the benefit of the lung screening program is greatly amplified, and patients can reduce risk for future cancers as well as cardiovascular and non-oncologic respiratory diseases. Smoking Cessation, Screening, tobacco