Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot

William K Evans; Martin C Tammemägi; Meghan J Walker; Erin Cameron; Yvonne W Leung; Sara Ashton; Julie de Loë; Wanda Doyle; Chantal Bornais; Ellen Allie; Koop Alkema; Caroline A Bravo; Caitlin McGarry; Michelle Rey; Rebecca Truscott; Gail Darling; Linda Rabeneck

doi:10.1016/j.jtho.2023.07.004

Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot

J Thorac Oncol. 2023 Oct;18(10):1323-1333. doi: 10.1016/j.jtho.2023.07.004. Epub 2023 Jul 6.

Authors

William K Evans¹, Martin C Tammemägi², Meghan J Walker³, Erin Cameron⁴, Yvonne W Leung⁵, Sara Ashton⁶, Julie de Loë⁷, Wanda Doyle⁸, Chantal Bornais⁷, Ellen Allie⁷, Koop Alkema⁹, Caroline A Bravo⁴, Caitlin McGarry⁴, Michelle Rey⁴, Rebecca Truscott⁴, Gail Darling⁴, Linda Rabeneck¹⁰

Affiliations

¹ Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada. Electronic address: billevans@cogeco.ca.
² Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St Catharines, Ontario, Canada.
³ Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁴ Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
⁵ Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; College of Professional Studies, Northeastern University-Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada.
⁶ Administration, Lakeridge Health, Oshawa, Ontario, Canada.
⁷ Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁸ Health Promotion Screening Program, Champlain Regional Cancer Program, Ottawa, Ontario, Canada.
⁹ Cancer Screening Program, Northeast Cancer Centre - Health Sciences North, Sudbury, Ontario, Canada.
¹⁰ Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 37422265
DOI: 10.1016/j.jtho.2023.07.004

Abstract

Introduction: Low-dose computed tomography screening in high-risk individuals reduces lung cancer mortality. To inform the implementation of a provincial lung cancer screening program, Ontario Health undertook a Pilot study, which integrated smoking cessation (SC).

Methods: The impact of integrating SC into the Pilot was assessed by the following: rate of acceptance of a SC referral; proportion of individuals who were currently smoking cigarettes and attended a SC session; the quit rate at 1 year; change in the number of quit attempts; change in Heaviness of Smoking Index; and relapse rate in those who previously smoked.

Results: A total of 7768 individuals were recruited predominantly through primary care physician referral. Of these, 4463 were currently smoking and were risk assessed and referred to SC services, irrespective of screening eligibility: 3114 (69.8%) accepted referral to an in-hospital SC program, 431 (9.7%) to telephone quit lines, and 50 (1.1%) to other programs. In addition, 4.4% reported no intention to quit and 8.5% were not interested in participating in a SC program. Of the 3063 screen-eligible individuals who were smoking at baseline low-dose computed tomography scan, 2736 (89.3%) attended in-hospital SC counseling. The quit rate at 1 year was 15.5% (95% confidence interval: 13.4%-17.7%; range: 10.5%-20.0%). Improvements were also observed in Heaviness of Smoking Index (p < 0.0001), number of cigarettes smoked per day (p < 0.0001), time to first cigarette (p < 0.0001), and number of quit attempts (p < 0.001). Of those who reported having quit within the previous 6 months, 6.3% had resumed smoking at 1 year. Furthermore, 92.7% of the respondents reported satisfaction with the hospital-based SC program.

Conclusions: On the basis of these observations, the Ontario Lung Screening Program continues to recruit through primary care providers, to assess risk for eligibility using trained navigators, and to use an opt-out approach to referral for cessation services. In addition, initial in-hospital SC support and intensive follow-on cessation interventions will be provided to the extent possible.

Keywords: LDCT screening; Lung cancer; Smoking cessation; Triage criteria.