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Harrison NJ, Riddiford‐Harland D, York S, Marshall HM, Rhee JJ, Stone E, Yap ML, Sharman AR, Weber M, McCullough SA, Byrne T, Paul CL, Bowden JA, Bonevski B, Rankin NM. 'Every Touch Point Is an Opportunity': Tobacco Control Experts' Views on How to Implement Smoking Cessation Interventions Within an Australian Lung Cancer Screening Program. Cancer Med 2025; 14:e70963. [PMID: 40387288 PMCID: PMC12086983 DOI: 10.1002/cam4.70963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 04/19/2025] [Accepted: 04/30/2025] [Indexed: 05/20/2025] Open
Abstract
BACKGROUND Targeted lung cancer screening (LCS) presents unique opportunities for smoking cessation among high-risk individuals. Implementation requires consideration of context-specific determinants. We sought perspectives from tobacco control/smoking cessation experts on optimally implementing smoking cessation interventions in an Australian LCS program. METHODS Recruitment was via maximum variation and snowball sampling in 2022. Individual/pair interviews explored factors that may influence acceptability and feasibility, potential delivery models, and implementation strategies. We interpreted interview data using codebook thematic analysis, then mapped key topics against the Consolidated Framework for Implementation Research and previous LCS expert-identified determinants. RESULTS Expert participants' (N = 30) roles included program/policy managers, researchers and clinicians, working in academia, not-for-profits/peak bodies and health departments. They emphasised the benefits of integrating smoking cessation interventions into routine LCS encounters. Key barriers included perceived professional and LCS participant reluctance, stigma, and rural access. Experts discouraged duplicating current cessation resources, and suggested prioritising implementation efforts. Flexible delivery models, addressing needs of priority populations (e.g., rural/remote, culturally and linguistically diverse), were recommended. Experts generally favoured a 'hybrid' intervention pathway, combining internal and external cessation services, to maximise feasibility and uptake. Training program staff on cessation intervention delivery and leadership buy-in were emphasised as essential requirements. DISCUSSION In this Australian tobacco control expert sample, there was near-unanimous support for embedding cessation interventions within routine LCS delivery and capitalising on opportunities to overcome current service delivery barriers. In conjunction with LCS participant perspectives, findings are relevant to planning and implementing cessation interventions in LCS contexts.
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Affiliation(s)
- Nathan J. Harrison
- Flinders Health and Medical Research Institute, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
- National Centre for Education and Training on Addiction (NCETA), Flinders Health and Medical Research Institute, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Diane Riddiford‐Harland
- Graduate School of Medicine, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
- Discipline of General Practice, School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyKensingtonNew South WalesAustralia
| | - Sarah York
- Centre for Health Policy, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Henry M. Marshall
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
- University of Queensland Thoracic Research Centre and Department of Thoracic MedicineThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Joel J. Rhee
- Graduate School of Medicine, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
- Discipline of General Practice, School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyKensingtonNew South WalesAustralia
| | - Emily Stone
- Department of Thoracic Medicine and Lung TransplantationSt. Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyKensingtonNew South WalesAustralia
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham InstituteUNSW SydneyLiverpoolNew South WalesAustralia
- George Institute for Global HealthUNSW SydneyBarangarooNew South WalesAustralia
- Liverpool and Macarthur Cancer Therapy CentresWestern Sydney UniversityCampbelltownNew South WalesAustralia
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Ashleigh R. Sharman
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Marianne Weber
- The Daffodil Centre, the University of Sydney, a Joint Venture With Cancer Council NSW, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Susan A. McCullough
- Consumer Panel, Thoracic Oncology Group of AustralasiaThornburyVictoriaAustralia
- Consumer Member, TROG Cancer ResearchWaratahNew South WalesAustralia
| | - Terri Byrne
- PC4 Community Advisory Group, Primary Care Collaborative Cancer Clinical Trials GroupMelbourneVictoriaAustralia
| | - Christine L. Paul
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Jacqueline A. Bowden
- Flinders Health and Medical Research Institute, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- National Centre for Education and Training on Addiction (NCETA), Flinders Health and Medical Research Institute, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
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Pebley K, Toll BA, Carpenter MJ, Silvestri G, Rojewski AM. Gain-Framed Text Messages and Nicotine Replacement Therapy for Smoking Cessation Among Lung Cancer Screening Patients: A Brief Report of a Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:543. [PMID: 40283767 PMCID: PMC12026912 DOI: 10.3390/ijerph22040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/24/2025] [Accepted: 04/01/2025] [Indexed: 04/29/2025]
Abstract
People who undergo lung cancer screening (LCS) and continue to smoke are at risk for negative clinical outcomes and lowered survival and need effective smoking cessation interventions. This pilot study tested an 8-week intervention for smoking cessation after LCS. The participants (N = 40) were randomized to the intervention group (combination nicotine replacement therapy [NRT] plus gain-framed text messaging for 8 weeks) or the control group (standard cessation counseling) after LCS. Assessments were completed at 8-week and 3-month follow-ups, including self-reported 7-day point prevalence abstinence. The mean age was 64.4 years old (SD = 6.2); 32.5% were Black or African American; and 55% were female. At Week 8, 14.3% (3/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group (p > 0.05). At 3-month follow-up, 4.8% (1/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group. Among the intervention group participants, up to 52.4% used the provided patches and up to 61.9% used the provided lozenges during the study period. This study demonstrated modest quit rates for LCS patients receiving gain-framed text messages and NRT. The results highlight the need for more effective smoking cessation interventions for this priority population.
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Affiliation(s)
- Kinsey Pebley
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St., Charleston, SC 29425, USA; (K.P.); (B.A.T.)
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425, USA; (M.J.C.); (G.S.)
| | - Benjamin A. Toll
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St., Charleston, SC 29425, USA; (K.P.); (B.A.T.)
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425, USA; (M.J.C.); (G.S.)
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA
| | - Matthew J. Carpenter
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425, USA; (M.J.C.); (G.S.)
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA
| | - Gerard Silvestri
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425, USA; (M.J.C.); (G.S.)
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, 135 Rutledge Ave., Charleston, SC 29425, USA
| | - Alana M. Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St., Charleston, SC 29425, USA; (K.P.); (B.A.T.)
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425, USA; (M.J.C.); (G.S.)
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He D, Lu H, Ou X, Zheng T, Zheng Z, Xu Z, Duan X, Li S. Exposure to major coronary heart disease events reduces lung cancer risk: a mendelian randomization study based on a European population. BMC Cancer 2025; 25:152. [PMID: 39871145 PMCID: PMC11770941 DOI: 10.1186/s12885-025-13485-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 01/09/2025] [Indexed: 01/29/2025] Open
Abstract
OBJECTIVE This study seeks to elucidate the causal relationship between major coronary heart disease events (MCHDE) and lung cancer incidence through mendelian randomization (MR), with the goal of providing evidence to inform more effective lung cancer screening and prevention strategies. METHODS Utilizing data from the IEU OpenGWAS project and FinnGen, this study employed a two-sample MR approach, with genetic variants serving as instrumental variables. Relevant single nucleotide polymorphisms (SNPs) associated with MCHDE and lung cancer were carefully selected, with particular attention given to mitigating potential confounders, such as smoking behaviors and statin use. RESULTS The MR analysis, utilizing FinnGen's MCHDE as the exposure factor, revealed a significant reduction in the incidence of non-small cell lung cancer (NSCLC) [odds ratio (OR) 0.893, 95% confidence interval (CI) 0.800-0.998] and small cell lung cancer (SCLC) [OR 0.684, 95% CI 0.500-0.936], highlighting the protective effect of MCHDE against these cancer subtypes. However, this protective effect was not observed for other types of lung cancer. Furthermore, substituting FinnGen's MCHDE with that from IEU OpenGWAS did not yield similar protective effects across various lung cancer subtypes. CONCLUSIONS This study suggests that MCHDE reduce the risk of NSCLC in the U.K. population and SCLC in the Finnish population. However, given that the underlying mechanism through which MCHDE reduces the risk of NSCLC and SCLC remains unclear, it is premature to conclude that individuals exposed to MCHDE do not require lung cancer screening.
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Affiliation(s)
- Dongming He
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China
| | - Hongting Lu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China
| | - Xinhuai Ou
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China
| | - Tiaozhan Zheng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China
| | - Zhiwen Zheng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China
| | - Zhanyu Xu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China.
| | - Xiaohong Duan
- Guangxi Minzu University, Guangxi Zhuang Autonomous Region, Nanning, 530006, P. R. China.
| | - Shikang Li
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, P. R. China.
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Fathi JT, Barry AM, Greenberg GM, Henschke CI, Kazerooni EA, Kim JJ, Mazzone PJ, Mulshine JL, Pyenson BS, Shockney LD, Smith RA, Wiener RS, White CS, Thomson CC. The American Cancer Society National Lung Cancer Roundtable strategic plan: Implementation of high-quality lung cancer screening. Cancer 2024; 130:3961-3972. [PMID: 39302235 DOI: 10.1002/cncr.34621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
More than a decade has passed since researchers in the Early Lung Cancer Action Project and the National Lung Screening Trial demonstrated the ability to save lives of high-risk individuals from lung cancer through regular screening by low dose computed tomography scan. The emergence of the most recent findings in the Dutch-Belgian lung-cancer screening trial (Nederlands-Leuvens Longkanker Screenings Onderzoek [NELSON]) further strengthens and expands on this evidence. These studies demonstrate the benefit of integrating lung cancer screening into clinical practice, yet lung cancer continues to lead cancer mortality rates in the United States. Fewer than 20% of screen eligible individuals are enrolled in lung cancer screening, leaving millions of qualified individuals without the standard of care and benefit they deserve. This article, part of the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) strategic plan, examines the impediments to successful adoption, dissemination, and implementation of lung cancer screening. Proposed solutions identified by the ACS NLCRT Implementation Strategies Task Group and work currently underway to address these challenges to improve uptake of lung cancer screening are discussed. PLAIN LANGUAGE SUMMARY: The evidence supporting the benefit of lung cancer screening in adults who previously or currently smoke has led to widespread endorsement and coverage by health plans. Lung cancer screening programs should be designed to promote high uptake rates of screening among eligible adults, and to deliver high-quality screening and follow-up care.
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Affiliation(s)
- Joelle T Fathi
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
- GO2 for Lung Cancer, Washington, District of Columbia, USA
| | - Angela M Barry
- GO2 for Lung Cancer, Washington, District of Columbia, USA
| | - Grant M Greenberg
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Phoenix Veterans Health Care System, Phoenix, Arizona, USA
| | - Ella A Kazerooni
- Department of Radiology, Michigan Medicine/University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Michigan Medicine/University of Michigan, Ann Arbor, Michigan, USA
| | - Jane J Kim
- Department of Veterans Affairs, National Center for Health Promotion and Disease Prevention, Durham, North Carolina, USA
| | - Peter J Mazzone
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James L Mulshine
- Department of Internal Medicine, Rush University Medical College, Chicago, Illinois, USA
| | | | - Lillie D Shockney
- Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Smith
- Center for Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carey C Thomson
- Department of Medicine, Division of Pulmonary and Critical Care, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Niranjan SJ, Tipre M, Hardy CM, Bowman T, Baskin ML. Empowering minoritized Alabamians screened for lung cancer-The Alabama Lung Cancer Awareness Screening and Education (ALCASE) project. Cancer Med 2024; 13:e70213. [PMID: 39400521 PMCID: PMC11472649 DOI: 10.1002/cam4.70213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 06/06/2024] [Accepted: 08/28/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND In Alabama only 4% of those eligible have been screened for lung cancer. The ALCASE project focused on navigating eligible individuals to lung cancer screening. METHODS Trained local staff enrolled screen eligible individuals from seven rural counties and one urban county. Demographics and knowledge of and barriers to lung cancer screening were collected using questionnaires. Education was provided and individuals were navigated to undergo screening. Descriptive statistics for enrolled and screened participants were computed using SAS 9.4. Debriefing interviews were conducted with the ALCASE staff regarding facilitators/barriers to implementing this project and lessons learned. Using NVivo, themes were identified through a combined deductive and inductive process. RESULTS In total, 447 people were contacted of which 257 were enrolled. Participants were predominantly African American (86.8%), female (56.8%), and 86.4% had health insurance. Study participants acknowledged the need for more education of lung cancer/screening procedures; help navigating clinics for screening services and having healthcare facilities close to home. The top five barriers to getting screened were transportation, financial issues, emotional concerns, healthcare insurance, and COVID-19. Of the 257, 106 participants (41%) completed a primary care referral and were screened for lung cancer. Debriefing interviews revealed: (i) Overall impressions of implementing ALCASE were positive. (ii) Barriers in implementing ALCASE were identified predominantly at the physician and institutional level. (iii) Facilitators in implementing ALCASE were identified at multiple levels. (iv) Suggestions on improving lung cancer screening leaned toward mitigating barriers at the institutional and structural level. CONCLUSION Ability to get screened is severely challenged by both personal and structural barriers.
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Affiliation(s)
- Soumya J. Niranjan
- Department of Health Services Administration, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Meghan Tipre
- Division of Hematology and Oncology, School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Claudia M. Hardy
- Division of Hematology/Oncology O'Neal Comprehensive Cancer CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tara Bowman
- O'Neal Comprehensive Cancer CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Monica L. Baskin
- Division of Hematology and Oncology, School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
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Gendarme S, Maitre B, Hanash S, Pairon JC, Canoui-Poitrine F, Chouaïd C. Beyond lung cancer screening, an opportunity for early detection of chronic obstructive pulmonary disease and cardiovascular diseases. JNCI Cancer Spectr 2024; 8:pkae082. [PMID: 39270051 PMCID: PMC11472859 DOI: 10.1093/jncics/pkae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/16/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Lung cancer screening programs concern smokers at risk for cardiovascular diseases (CVDs) and chronic obstructive pulmonary disease (COPD). The LUMASCAN (LUng Cancer Screening, MArkers and low-dose computed tomography SCANner) study aimed to evaluate the acceptability and feasibility of screening for these 3 diseases in a community population with centralized organization and to determine low-dose computed tomography (CT) markers associated with each disease. METHODS This cohort enrolled participants meeting National Comprehensive Cancer Network criteria (v1.2014) in an organized lung cancer-screening program including low-dose CT scans; spirometry; evaluations of coronary artery calcifications (CACs); and a smoking cessation plan at inclusion, 1, and 2 years; then telephone follow-up. Outcomes were the participation rate and the proportion of participants affected by lung cancer, obstructive lung disease, or CVD events. Logistic-regression models were used to identify radiological factors associated with each disease. RESULTS Between 2016 and 2019, a total of 302 participants were enrolled: 61% men; median age 58.8 years; 77% active smoker; 11% diabetes; 38% hypertension; and 27% taking lipid-lowering agents. Inclusion, 1-year, and 2-year participation rates were 99%, 81%, 79%, respectively. After a median follow-up of 5.81 years, screenings detected 12 (4%) lung cancer, 9 of 12 via low-dose CT (78% localized) and 3 of 12 during follow-up (all stage IV), 83 (27%) unknown obstructive lung disease, and 131 (43.4%) moderate to severe CACs warranting a cardiology consultation. Preexisting COPD and moderate to severe CACs were associated with major CVD events with odds ratios of 1.98 (95% confident interval [CI] = 1.00 to 3.88) and 3.27 (95% CI = 1.72 to 6.43), respectively. CONCLUSION The LUMASCAN study demonstrated the feasibility of combined screening for lung cancer, COPD, and CVD in a community population. Its centralized organization enabled high participation and coordination of healthcare practitioners.
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Affiliation(s)
- Sébastien Gendarme
- Pulmonology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Bernard Maitre
- Pulmonology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Sam Hanash
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Claude Pairon
- Inserm U955, IMRB, Université Paris-Est Créteil, Créteil, France
- Occupational Medicine Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Inserm U955, IMRB, Université Paris-Est Créteil, Créteil, France
- Public Health Department, Henri-Mondor Hospital, Créteil, France
| | - Christos Chouaïd
- Pulmonology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, IMRB, Université Paris-Est Créteil, Créteil, France
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Pistelli F, Meschi C, Carrozzi L. Smoking cessation in lung cancer screening: can a smartphone help? THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100976. [PMID: 39050230 PMCID: PMC11266647 DOI: 10.1016/j.lanepe.2024.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Francesco Pistelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Claudia Meschi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
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Tan NQP, Volk RJ, Leal VB, Lettieri JS, Bailey LA, Ylioja T, Celestino P, Lowenstein LM. Tobacco quitline staffs' knowledge and attitudes about connecting quitline callers to lung cancer screening educational materials. Cancer Med 2024; 13:e7443. [PMID: 38940442 PMCID: PMC11212000 DOI: 10.1002/cam4.7443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE To evaluate the impact of training quitline staff in lung cancer screening (LCS) on knowledge and attitudes towards connecting quitline callers to LCS educational materials. METHODS We conducted a pre-post evaluation within a larger implementation project in the U.S. to support LCS among quitline callers. From July 2020 to June 2021, staff from four quitline service providers completed surveys before and after training on LCS knowledge. After training, staff completed the acceptability of intervention measure, intervention appropriateness measure, and feasibility of the intervention measure. RESULTS A total of 245 staff completed the initial demographic survey (analytic sample), 130 completed the pre-training survey, and 225 completed the post-training survey. Staff were on average 47.4 years old and 76.7% were female. LCS knowledge improved after the training (n = 120, mean difference = +26.5%, 95% CI 21.6, 31.4, p < 0.001). Overall, staff felt that connecting quitline callers to LCS education materials was acceptable (M = 4.0, SD = 0.8), appropriate (M = 4.1, SD = 0.7), and feasible (M = 4.0, SD = 0.7). CONCLUSIONS Receiving training about LCS eligibility and the benefits and harms of screening improved LCS knowledge among quitline staff. Quitline staff found that connecting callers with LCS educational materials is acceptable, appropriate, and feasible, and aligned with their primary mission.
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Affiliation(s)
- Naomi Q. P. Tan
- Rutgers Cancer Institute and the Robert Wood Johnson Medical School, Rutgers UniversityNew BrunswickNew JerseyUSA
| | - Robert J. Volk
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Viola B. Leal
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Kerpel-Fronius A, Megyesfalvi Z, Markóczy Z, Solymosi D, Csányi P, Tisza J, Kecskés A, Baranyi B, Csánky E, Dóka A, Gálffy G, Göcző K, Győry C, Horváth Z, Juhász T, Kállai Á, Kincses ZT, Király Z, Király-Incze E, Kostyál L, Kovács A, Kovács A, Kuczkó É, Makra Z, Maurovich Horvát P, Merth G, Moldoványi I, Müller V, Pápai-Székely Z, Papp D, Polgár C, Rózsa P, Sárosi V, Szalai Z, Székely A, Szuhács M, Tárnoki D, Tavaszi G, Turóczi-Kirizs R, Tóth L, Urbán L, Vaskó A, Vigh É, Dome B, Bogos K. HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program. Eur Radiol 2024; 34:3462-3470. [PMID: 37921926 DOI: 10.1007/s00330-023-10379-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. METHODS A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. RESULTS The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001). CONCLUSIONS HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary. CLINICAL RELEVANCE STATEMENT HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region. KEY POINTS • Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary.
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Affiliation(s)
| | - Zsolt Megyesfalvi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Zsolt Markóczy
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Diana Solymosi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Péter Csányi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Tisza
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Anita Kecskés
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | | | - Eszter Csánky
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Adrienn Dóka
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | | | - Katalin Göcző
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Csilla Győry
- Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Zsolt Horváth
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tünde Juhász
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | - Árpád Kállai
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | - Zsigmond T Kincses
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Király
- Pulmonological Institute of Veszprém County, Farkasgyepű, Hungary
| | - Enikő Király-Incze
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - László Kostyál
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Anita Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Kovács
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | - Éva Kuczkó
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Zsuzsanna Makra
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | | | | | | | | | - Zsolt Pápai-Székely
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - Dávid Papp
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Csaba Polgár
- National Institute of Oncology, Budapest, Hungary
| | - Péter Rózsa
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
- MediConcept, Budapest, Hungary
| | - Veronika Sárosi
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | | | | | - Marianna Szuhács
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | | | - Gábor Tavaszi
- Törökbálint Institute of Pulmonology, Törökbálint, Hungary
| | | | | | | | | | - Éva Vigh
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Budapest, Hungary.
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Translational Medicine, Lund University, Lund, Sweden.
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Budapest, Hungary
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10
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Shoenbill KA, Goldstein AO. Better Together: Advancing Tobacco Use Treatment and Lung Cancer Screening. J Thorac Oncol 2024; 19:531-533. [PMID: 38582544 DOI: 10.1016/j.jtho.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Kimberly A Shoenbill
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; Program on Health and Clinical Informatics, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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11
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Smith P, Murray RL, Crosbie PA. Integrated stop smoking interventions are essential to maximise the health benefits from lung cancer screening. Thorax 2024; 79:198-199. [PMID: 38216316 DOI: 10.1136/thorax-2023-221037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Pamela Smith
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Philip A Crosbie
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
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12
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Chen L, Zhou Y, Cheng H, Lu W, Cai M, Jiang K. Circ-SATB2 (hsa_circ_0008928) and miR-150-5p are regulators of TRIM66 in the regulation of NSCLC cell growth and metastasis of NSCLC cells via the ceRNA pathway. J Biochem Mol Toxicol 2024; 38:e23615. [PMID: 38084627 DOI: 10.1002/jbt.23615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/27/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
Circular RNA (circRNA) was an important modulator and potential molecular target of nonsmall cell lung cancer (NSCLC). CircSATB2 was reported to be upregulated in NSCLC. However, the role and mechanism of circSATB2 in NSCLC progression remain to be illustrated. The RNA and protein expression was detected by quantitative real-time polymerase chain reaction, western blot, and immunohistochemistry assay. Cell counting kit-8, cell colony formation, and 5-ethynyl-2'-deoxyuridine assays were applied to assess cell growth. The migrated and invaded cells were examined by transwell assay. Flow cytometry was performed to measure apoptotic cells. The interaction among circSATB2, microRNA-150-5p (miR-150-5p), and tripartite motif-containing protein 66 (TRIM66) was identified by dual-luciferase reporter assay and RNA immunoprecipitation assay. An in vivo experiment was conducted to investigate the effect of circSATB2 on tumor growth. CircSATB2 expression was highly expressed in NSCLC tissues and cell lines. CircSATB2 and TRIM66 silencing both suppressed NSCLC cell growth, migration, and invasion whereas promoted NSCLC cell apoptosis. CircSATB2 acted as a molecular sponge for miR-150-5p, and miR-150-5p interacted with the 3' untranslated region (3'UTR) of TRIM66. Moreover, circSATB2 knockdown-induced effects were partly reversed by TRIM66 overexpression in NSCLC cells. Besides, cirSATB2 expression was negatively correlated with miR-150-5p level and positively correlated with TRIM66 level in NSCLC tumor tissues. CircSATB2 knockdown blocked xenograft tumor growth in vivo. In summary, this study verified that circSATB2 stimulated NSCLC cell malignant behaviors by miR-150-5p/TRIM66 pathway, providing a possible circRNA-targeted therapy for NSCLC.
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Affiliation(s)
- Liangji Chen
- Medical Clinical Laboratory, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao City, Hubei Province, China
| | - Yuting Zhou
- Medical Clinical Laboratory, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao City, Hubei Province, China
| | - Hongbing Cheng
- Thoracic Surgery, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao City, Hubei Province, China
| | - Wenjing Lu
- Department of Oncology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao City, Hubei Province, China
| | - Mengyang Cai
- Medical Clinical Laboratory, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao City, Hubei Province, China
| | - Kaifeng Jiang
- Clinical Laboratory, The Central Hospital of Yongzhou, Yongzhou City, Hunan Province, China
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13
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Shusted CS, Mukhtar S, Lee J, Ruane B, Muse E, Emeigh-McBride L, Gatson-Anderson E, Kane GC, Wen KY, Juon HS, Barta JA. Factors Associated With Receipt of Tobacco Treatment Integrated With Nurse Navigation in a Centralized Lung Cancer Screening Program at an Urban Academic Medical Center. Cancer Control 2024; 31:10732748241304966. [PMID: 39653391 PMCID: PMC11629410 DOI: 10.1177/10732748241304966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 11/12/2024] [Accepted: 11/18/2024] [Indexed: 12/12/2024] Open
Abstract
PURPOSE Optimal approaches for tobacco treatment counseling among individuals who currently smoke and are undergoing shared decision-making (SDM) and lung cancer screening (LCS) are unknown. The objective of this cross-sectional study was to determine the rate of reported interest in tobacco treatment counseling and pharmacotherapy among individuals who currently smoke and are receiving integrated nurse navigation for LCS and tobacco treatment in a centralized LCS Program. METHODS We identified individuals undergoing SDM through our centralized LCS Program between March 2021 and March 2022. The LCS Program tobacco treatment protocol includes counseling both in-person and via telephone during SDM, LCS results review, and an optional 4-week follow-up. Sociodemographic and clinical data for currently smoking individuals participating in LCS were extracted from the LCS Registry. RESULTS Among 1034 individuals undergoing LCS through the centralized program, 605 were currently smoking and comprised the study cohort. Nearly half (49.8%) reported interest in tobacco treatment counseling and pharmacotherapy and received a personalized treatment plan. On multivariate analysis, factors significantly associated with expressing interest in treatment included African-American/Black race, higher educational attainment, and returning visit type. Among the 301 individuals expressing interest in tobacco treatment, 35 (11.6%) had documentation of self-reported smoking cessation in the electronic health record. Successful smoking cessation for any length of time was significantly associated with receiving at least one longitudinal tobacco cessation counseling telephone call. CONCLUSIONS In a centralized LCS Program offering tobacco treatment integrated with screening services, race, education, and visit type were significantly associated with expressing interest in tobacco treatment counseling and pharmacotherapy, while longitudinal tobacco counseling telephone calls were associated with smoking cessation. Randomized controlled trials are needed to test whether this integrated strategy leads to LCS- and tobacco-related outcomes.
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Affiliation(s)
- Christine S. Shusted
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah Mukhtar
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - James Lee
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brooke Ruane
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Emily Muse
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence Emeigh-McBride
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eboni Gatson-Anderson
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory C. Kane
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kuang-Yi Wen
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julie A. Barta
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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14
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Lu Y, Luo J, Huo Z, Ge F, Chen Y, Chen Y, Zhang Q, Li C, Wang J, Gan J, Cheng Z, Li Y, Feng Y, Hu Q, He J, Liang W. Causal effect of beta-blockers on the risk of lung cancer: a Mendelian randomization study. J Thorac Dis 2023; 15:6651-6660. [PMID: 38249886 PMCID: PMC10797374 DOI: 10.21037/jtd-23-1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/03/2023] [Indexed: 01/23/2024]
Abstract
Background It remains uncertain whether there is a causal association of the use of beta-blockers (BBs) on lung cancer risk. We used a two-sample Mendelian randomization (MR) approach to identify the causal association of BBs and lung cancer risk. Methods Twenty-two BB-related single-nucleotide polymorphisms (SNPs) were obtained from the UK Biobank as the instrumental variables (IVs). Genetic summary data information of lung cancer was extracted from the International Lung Cancer Consortium, with a total of 11,348 cases and 15,861 controls. We adopted the inverse-variance weighted (IVW) approach to conduct the MR analyses. Egger-intercept analysis was further performed as sensitivity analysis for pleiotropy evaluation. Additionally, we investigated whether BBs could causally affect the risk of lung cancer through their pharmacological effects. Results The current IVW analysis suggested a decreased lung cancer risk in BB users [odds ratio (OR) =0.83; 95% confidence interval (CI): 0.73-0.95; P<0.01]. Results of Egger-intercept analysis demonstrated that no pleiotropy was found (P=0.94), which suggested the robustness of the causality. However, there was little evidence that pharmacological effects mediate the association between BBs and lung cancer. Conclusions The current analysis suggested that BBs could decrease the risk of lung cancer but may be not via its pharmacological effects. Further research is in need for elucidating the underlying mechanisms.
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Affiliation(s)
- Yi Lu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jiachun Luo
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Zhenyu Huo
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Ge
- First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Yang Chen
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Qing Zhang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jinhui Wang
- Second Clinical School, Wenzhou Medical University, Wenzhou, China
| | - Jiayu Gan
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ziqiu Cheng
- First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Yangbin Li
- First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Yi Feng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Qiyuan Hu
- First Clinical Medical School, the First Hospital, Shanxi Medical University, Taiyuan, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- Department of Oncology, the First People’s Hospital of Zhaoqing, Zhaoqing, China
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15
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Hartley-Blossom Z, Cardona-Del Valle A, Muns-Aponte C, Udayakumar N, Carlos RC, Flores EJ. Advancing Health Equity in Lung Cancer Screening and the Role of Humanomics. Thorac Surg Clin 2023; 33:365-373. [PMID: 37806739 PMCID: PMC10622157 DOI: 10.1016/j.thorsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Identifying and managing lung cancer, the leading cause of cancer-specific mortality, depend on multiple medical and sociodemographic factors. Humanomics is a model that acknowledges that negative societal stressors from systemic inequity affect individual health by altering pro-inflammatory gene expression. The same factors which may predispose individuals to lung cancer may also obstruct equitably prompt diagnosis and treatment. Increasing lung cancer screening access can lessen disparities in outcomes among disproportionately affected communities. Here, the authors describe several individual, provider, and health system-level obstacles to lung cancer screening and offer actionable solutions to increase access.
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Affiliation(s)
- Zachary Hartley-Blossom
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Alejandra Cardona-Del Valle
- Department of Radiology, University of Puerto Rico School of Medicine, Rio Piedras Medical Center Americo Miranda Avenue, San Juan, 00936, Puerto Rico
| | - Claudia Muns-Aponte
- Department of Radiology, University of Puerto Rico School of Medicine, Rio Piedras Medical Center Americo Miranda Avenue, San Juan, 00936, Puerto Rico
| | - Neha Udayakumar
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ste C21, Ann Arbor, MI 48109, USA
| | - Efren J Flores
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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16
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Evans WK, Tammemägi MC, Walker MJ, Cameron E, Leung YW, Ashton S, de Loë J, Doyle W, Bornais C, Allie E, Alkema K, Bravo CA, McGarry C, Rey M, Truscott R, Darling G, Rabeneck L. Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot. J Thorac Oncol 2023; 18:1323-1333. [PMID: 37422265 DOI: 10.1016/j.jtho.2023.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
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.
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Affiliation(s)
- William K Evans
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
| | - Martin C Tammemägi
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Meghan J Walker
- 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
| | - Erin Cameron
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yvonne W Leung
- 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
| | - Sara Ashton
- Administration, Lakeridge Health, Oshawa, Ontario, Canada
| | - Julie de Loë
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wanda Doyle
- Health Promotion Screening Program, Champlain Regional Cancer Program, Ottawa, Ontario, Canada
| | - Chantal Bornais
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ellen Allie
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Koop Alkema
- Cancer Screening Program, Northeast Cancer Centre - Health Sciences North, Sudbury, Ontario, Canada
| | - Caroline A Bravo
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Caitlin McGarry
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michelle Rey
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Rebecca Truscott
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gail Darling
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Linda Rabeneck
- 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
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17
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Caballeros Lam M, Pujols P, Ezponda Casajús A, Guillén Valderrama F, García Velloso MJ, Wyss A, García Del Barrio L, Larrache Latasa J, Pueyo Villoslada J, Lozano Escario MD, de-Torres JP, Alcaide Ocaña AB, Campo Ezquibela A, Seijo Maceiras L, Montuenga Badía L, Zulueta J, Iñarrairaegui Bastarrica M, Herrero Santos I, Bastarrika Alemañ G. Lung cancer screening using low-dose CT and FDG-PET in liver transplant recipients. Liver Transpl 2023; 29:1100-1108. [PMID: 36929835 DOI: 10.1097/lvt.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
To address the feasibility of implementing a lung cancer screening program in liver transplant recipients (LTR) targeted to detect early-stage lung cancer one hundred twenty-four LTR (89% male, 59.8+/-8.8 y old), who entered the lung cancer screening program at our hospital were reviewed. The results of the diagnostic algorithm using low-dose CT and F-18-fluorodeoxyglycose positron emission tomography (FDG-PET) were analyzed. Lung cancer was detected in 12 LTR (9.7%), most of which corresponded to the non-small cell subtype. Two of the 12 lung cancers were detected in the baseline study (prevalence of 1.6%), whereas 10 patients were diagnosed with lung cancer in the follow-up (incidence of 8.1%). Considering all cancers, 10 of 12 (83.3%) were diagnosed at stage I, one cancer was diagnosed at stage IIIA, and another one at stage IV. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of F-18-fluorodeoxyglycose positron emission tomography to detect malignancy in our cohort were 81.8%,100%, 99.3%, 100%, and 99.3%, respectively. A carefully followed multidisciplinary lung cancer screening algorithm in LTR that includes F-18-fluorodeoxyglycose positron emission tomography and low-dose CT allows lung cancer to be diagnosed at an early stage while reducing unnecessary invasive procedures.
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Affiliation(s)
| | - Paula Pujols
- School of Medicine, University of Navarra, Pamplona, Spain
| | | | | | | | - Alejandra Wyss
- Department of Geological and Mining Engineering. Universidad Politécnica de Madrid
| | | | | | | | | | - Juan P de-Torres
- Department of Pulmonary, Clinica Universidad de Navarra, Pamplona, Spain
| | | | | | | | - Luis Montuenga Badía
- Solid tumors and biomarkers program, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Javier Zulueta
- Department of Pulmonary, Mount Sinai Morningside, New York, USA
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18
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Fu SS, Rothman AJ, Vock DM, Lindgren BR, Almirall D, Begnaud A, Melzer AC, Schertz KL, Branson M, Haynes D, Hammett P, Joseph AM. Optimizing Longitudinal Tobacco Cessation Treatment in Lung Cancer Screening: A Sequential, Multiple Assignment, Randomized Trial. JAMA Netw Open 2023; 6:e2329903. [PMID: 37615989 PMCID: PMC10450571 DOI: 10.1001/jamanetworkopen.2023.29903] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
Importance Nearly half of the 14.8 million US adults eligible for lung cancer screening (LCS) smoke cigarettes. The optimal smoking cessation program components for the LCS setting are unclear. Objective To assess the effect of adding a referral to prescription medication therapy management (MTM) to the tobacco longitudinal care (TLC) program among patients eligible for LCS who smoke and do not respond to early tobacco treatment and to assess the effect of decreasing the intensity of TLC among participants who do respond to early treatment. Design, Setting, and Participants This randomized clinical trial included patients who currently smoked cigarettes daily and were eligible for LCS. Recruitment took place at primary care centers and LCS programs at 3 large health systems in the US and began in October 2016, and 18-month follow-up was completed April 2021. Interventions (1) TLC comprising intensive telephone coaching and combination nicotine replacement therapy for 1 year with at least monthly contact; (2) TLC with MTM, MTM offered pharmacist-referral for prescription medications; and (3) Quarterly TLC, intensity of TLC was decreased to quarterly contact. Intervention assignments were based on early response to tobacco treatment (abstinence) that was assessed either 4 weeks or 8 weeks after treatment initiation. Main outcomes and Measures Self-reported, 6-month prolonged abstinence at 18-month. Results Of 636 participants, 228 (35.9%) were female, 564 (89.4%) were White individuals, and the median (IQR) age was 64.3 (59.6-68.8) years. Four weeks or 8 weeks after treatment initiation, 510 participants (80.2%) continued to smoke (ie, early treatment nonresponders) and 126 participants (19.8%) had quit (ie, early treatment responders). The 18 month follow-up survey response rate was 83.2% (529 of 636). Across TLC groups at 18 months follow-up, the overall 6-month prolonged abstinence rate was 24.4% (129 of 529). Among the 416 early treatment nonresponders, 6-month prolonged abstinence for TLC with MTM vs TLC was 17.8% vs 16.4% (adjusted odds ratio [aOR] 1.13; 95% CI, 0.67-1.89). In TLC with MTM, 98 of 254 participants (39%) completed at least 1 MTM visit. Among 113 early treatment responders, 6-month prolonged abstinence for Quarterly TLC vs TLC was 24 of 55 (43.6%) vs 34 of 58 (58.6%) (aOR, 0.54; 95% CI, 0.25-1.17). Conclusions and Relevance In this randomized clinical trial, adding referral to MTM with TLC for participants who did not respond to early treatment did not improve smoking abstinence. Stepping down to Quarterly TLC among early treatment responders is not recommended. Integrating longitudinal tobacco cessation care with LCS is feasible and associated with clinically meaningful quit rates. Trial Registration ClinicalTrials.gov Identifier: NCT02597491.
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Affiliation(s)
- Steven S. Fu
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
| | | | - David M. Vock
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Bruce R. Lindgren
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Daniel Almirall
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Abbie Begnaud
- Department of Medicine, University of Minnesota, Minneapolis
| | - Anne C. Melzer
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
| | | | - Mariah Branson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - David Haynes
- Institute for Health Informatics, University of Minnesota, Minneapolis
| | - Patrick Hammett
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
| | - Anne M. Joseph
- Department of Medicine, University of Minnesota, Minneapolis
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19
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Foley KL, Dressler EV, Weaver KE, Sutfin EL, Miller DP, Bellinger C, Kittel C, Stone RJ, Petty WJ, Land SR, Spangler JG, Lesser GJ, Chiles C. The Optimizing Lung Screening Trial (WF-20817CD): Multicenter Randomized Effectiveness Implementation Trial to Increase Tobacco Use Cessation for Individuals Undergoing Lung Screening. Chest 2023; 164:531-543. [PMID: 36931460 PMCID: PMC10410244 DOI: 10.1016/j.chest.2023.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter. RESEARCH QUESTION Was the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities? STUDY DESIGN AND METHODS The OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86% retention rate). Fifty-four percent of those who reported not using tobacco at 6 months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence. RESULTS The average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0% at baseline to approximately 13% at 6 months; P < .0001), tobacco use did not differ by trial group at 14 days (OR, 0.96; 95% CI, 0.46-1.99; P = .90), 3 months (OR, 1.17; 95% CI, 0.69-1.99; P = .56), or 6 months (OR, 0.97; 95% CI, 0.65-1.43; P = .87). INTERPRETATION The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03291587; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Kristie L Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - David P Miller
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christina Bellinger
- Department of Pulmonology and Critical Care, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rebecca J Stone
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - W Jeffrey Petty
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Glenn J Lesser
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Caroline Chiles
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
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20
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Mascalchi M, Picozzi G, Puliti D, Diciotti S, Deliperi A, Romei C, Falaschi F, Pistelli F, Grazzini M, Vannucchi L, Bisanzi S, Zappa M, Gorini G, Carozzi FM, Carrozzi L, Paci E. Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed. Diagnostics (Basel) 2023; 13:2197. [PMID: 37443590 DOI: 10.3390/diagnostics13132197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55-69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, 50121 Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 47521 Cesena, Italy
| | - Annalisa Deliperi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Chiara Romei
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Fabio Falaschi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Michela Grazzini
- Division of Pneumonology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Letizia Vannucchi
- Division of Radiology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Simonetta Bisanzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Francesca Maria Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
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21
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Magoc T, Everson R, Harle CA. Enhancing an enterprise data warehouse for research with data extracted using natural language processing. J Clin Transl Sci 2023; 7:e149. [PMID: 37456264 PMCID: PMC10346024 DOI: 10.1017/cts.2023.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This study aims to develop a generalizable architecture for enhancing an enterprise data warehouse for research (EDW4R) with results from a natural language processing (NLP) model, which allows discrete data derived from clinical notes to be made broadly available for research use without need for NLP expertise. The study also quantifies the additional value that information extracted from clinical narratives brings to EDW4R. Materials and methods Clinical notes written during one month at an academic health center were used to evaluate the performance of an existing NLP model and to quantify its value added to the structured data. Manual review was utilized for performance analysis. The architecture for enhancing the EDW4R is described in detail to enable reproducibility. Results Two weeks were needed to enhance EDW4R with data from 250 million clinical notes. NLP generated 16 and 39% increase in data availability for two variables. Discussion Our architecture is highly generalizable to a new NLP model. The positive predictive value obtained by an independent team showed only slightly lower NLP performance than the values reported by the NLP developers. The NLP showed significant value added to data already available in structured format. Conclusion Given the value added by data extracted using NLP, it is important to enhance EDW4R with these data to enable research teams without NLP expertise to benefit from value added by NLP models.
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Affiliation(s)
- Tanja Magoc
- College of Medicine, University of Florida, Gainesville, FL, USA
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22
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Huang S, Tang O, Zheng X, Li H, Wu Y, Yang L. Effectiveness of smoking cessation on the high-risk population of lung cancer with early screening: a systematic review and meta-analysis of randomized controlled trials until January 2022. Arch Public Health 2023; 81:101. [PMID: 37268972 DOI: 10.1186/s13690-023-01111-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/16/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Lung cancer has always been the malignant tumor with the highest incidence rate. Smoking is the most important risk factor for lung cancer. Although potential positive effects of smoking cessation interventions on the high-risk population of lung cancer have been observed, evidence of its definitive effect remains uncertain. This study aimed to summarize the evidence related to the effects and safety of smoking cessation interventions for the high-risk population of lung cancer. METHODS A systematic literature search was conducted through the following seven databases: PubMed, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, and Science Direct. Screening and assessment for risk of bias were conducted by two independent reviewers. Meta-analysis was performed for the 7-day-point prevalence of smoking abstinence and continuous smoking abstinence using RevMan 5.3 software. RESULTS Meta-analysis results show that in the 7-day-point prevalence of smoking abstinence (by patient-reported outcome): individualized intervention was significantly higher than that of the standard care [RR = 1.46, 95%CI = (1.04,2.06), P < 0.05]. Moreover, the smoking cessation interventions were significantly elevated than that of standard care [RR = 1.58, 95%CI = (1.12, 2.23), P < 0.05] within 1-6 month follow-up time. In line with the findings in cigarette smoking, the continuous smoking abstinence of E-cigarettes (biochemical verified): E-cigarettes were significantly higher than that of the standard care [RR = 1.51, 95%CI = (1.03, 2.21), P < 0.05], and within 1-6 month follow-up time, the smoking cessation interventions were significantly greater than that of standard care [RR = 1.51, 95%CI = (1.03, 2.21), P < 0.05]. Publication bias was detected possibly. CONCLUSIONS The results of this systematic review show that smoking cessation intervention is effective for long-term lung cancer high-risk smokers who participate in early screening, of which E-cigarettes are the best, followed by individual smoking cessation. TRIAL REGISTRATION A review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO). TRIAL REGISTRATION CRD42019147151. Registered 23 June 2022.
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Affiliation(s)
- Simin Huang
- School of Nursing, Fujian University of Traditional Chinese Medicine-Fuzhou, Fuzhou, China
| | - Oufeng Tang
- Department of Anesthesiology, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University-Chengdu, Chengdu, China
| | - Xutong Zheng
- School of Nursing, Fujian University of Traditional Chinese Medicine-Fuzhou, Fuzhou, China
| | - Hui Li
- School of Nursing, Fujian University of Traditional Chinese Medicine-Fuzhou, Fuzhou, China
| | - Yuxin Wu
- Ji'an College-Ji'an, Ji'an, China
| | - Liu Yang
- School of Nursing, Fujian University of Traditional Chinese Medicine-Fuzhou, Fuzhou, China.
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23
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Adams SJ, Stone E, Baldwin DR, Vliegenthart R, Lee P, Fintelmann FJ. Lung cancer screening. Lancet 2023; 401:390-408. [PMID: 36563698 DOI: 10.1016/s0140-6736(22)01694-4] [Citation(s) in RCA: 185] [Impact Index Per Article: 92.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Randomised controlled trials, including the National Lung Screening Trial (NLST) and the NELSON trial, have shown reduced mortality with lung cancer screening with low-dose CT compared with chest radiography or no screening. Although research has provided clarity on key issues of lung cancer screening, uncertainty remains about aspects that might be critical to optimise clinical effectiveness and cost-effectiveness. This Review brings together current evidence on lung cancer screening, including an overview of clinical trials, considerations regarding the identification of individuals who benefit from lung cancer screening, management of screen-detected findings, smoking cessation interventions, cost-effectiveness, the role of artificial intelligence and biomarkers, and current challenges, solutions, and opportunities surrounding the implementation of lung cancer screening programmes from an international perspective. Further research into risk models for patient selection, personalised screening intervals, novel biomarkers, integrated cardiovascular disease and chronic obstructive pulmonary disease assessments, smoking cessation interventions, and artificial intelligence for lung nodule detection and risk stratification are key opportunities to increase the efficiency of lung cancer screening and ensure equity of access.
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Affiliation(s)
- Scott J Adams
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Stone
- Faculty of Medicine, University of New South Wales and Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital and National University of Singapore, Singapore
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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24
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Thomas NA, Ward R, Tanner NT, Rojewski AM, Toll B, Gebregziabher M, Silvestri GA. Factors Associated With Smoking Cessation Attempts in Lung Cancer Screening: A Secondary Analysis of the National Lung Screening Trial. Chest 2023; 163:433-443. [PMID: 36162480 PMCID: PMC10103689 DOI: 10.1016/j.chest.2022.08.2239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Lung cancer remains the leading cause of cancer-related mortality in the United States. The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality resulting from lung cancer screening (LCS) with an additive reduction from smoking abstinence. However, successful smoking cessation within LCS is variable. RESEARCH QUESTION What patient and treatment factors are associated with attempts to quit smoking among those screened for lung cancer? STUDY DESIGN AND METHODS In a secondary analysis of the American College of Radiology Imaging Network arm of the NLST, patient demographics, patient smoking behaviors, and tobacco treatment variables were stratified by patient smoking status. The Cox proportional hazards ratio was used to evaluate each variable's effect on attempting to quit smoking. RESULTS Seven thousand three hundred sixty-nine patients were smoking actively at enrollment in the NLST. Of the patients who reported they were smoking, 73.4% did not receive any pharmacologic tobacco treatment. More patients who attempted to quit received pharmacologic tobacco treatment than those who continued to smoke: (nicotine replacement therapy [NRT], 18.0% vs 12.4% [P < .01]; bupropion, 7.9% vs 6.9% [P = .02]; both NRT and bupropion, 5.6% vs 3.9% [P < .01]). Stable users were more likely to be women (47.8% vs 43.8%; P < .01), to be African American (8.2% vs 6.3%; P = .007), to be unmarried (43.2% vs 36.9% [P < .01]), and to have less than a college education (47.7% vs 42.3%; P < .01). Patients with high dependence who received dual therapy with bupropion and NRT showed the highest likelihood of quit attempt (hazard ratio, 2.07; 95% CI, 1.75-2.44). INTERPRETATION In this analysis, only one-quarter of patients who underwent LCS and who smoked were treated with pharmacologic therapy, which is associated with increased likelihood of attempting to quit. Certain characteristics are associated with difficulty with attempting to quit smoking. Those with high nicotine dependence benefitted most from dual pharmacologic therapy.
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Affiliation(s)
- Nina A Thomas
- Division of Pulmonary and Critical Care, CU Cancer Center, University of Colorado, Denver, CO.
| | - Ralph Ward
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Nichole T Tanner
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Benjamin Toll
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Gerard A Silvestri
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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25
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Immediate, Remote Smoking Cessation Intervention in Participants Undergoing a Targeted Lung Health Check: Quit Smoking Lung Health Intervention Trial, a Randomized Controlled Trial. Chest 2023; 163:455-463. [PMID: 35932889 PMCID: PMC9899638 DOI: 10.1016/j.chest.2022.06.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. RESEARCH QUESTION Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? STUDY DESIGN AND METHODS In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression. RESULTS Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. INTERPRETATION Immediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. TRIAL REGISTRY ISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com.
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Nightingale C, Bavor C, Stone E, Rankin NM. Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region. JCO Glob Oncol 2023; 9:e2200329. [PMID: 36749907 PMCID: PMC10166439 DOI: 10.1200/go.22.00329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- Claire Nightingale
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Claire Bavor
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emily Stone
- Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Nicole M. Rankin
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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Cooley ME, Castaldi PJ, Mazzola E, Blazey MU, Nayak MM, Healey MJ, Lathan CS, Borondy-Kitts A, DeMarco RF, Kim SS. Protocol for a randomized controlled trial of the Enhanced Smoking Cessation Approach to Promote Empowerment (ESCAPE) digitalized intervention to promote lung health in high-risk individuals who smoke. Contemp Clin Trials 2023; 124:107005. [PMID: 36396069 DOI: 10.1016/j.cct.2022.107005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Low dose computed tomography (LDCT) is an effective screening test to decrease lung cancer deaths. Lung cancer screening may be a teachable moment helping people who smoke to quit, which may result in increased benefit of screening. Innovative strategies are needed to engage high-risk individuals in learning about LDCT screening. More precise methods such as polygenic risk scores quantify genetic predisposition to tobacco use, and optimize lung health interventions. We present the ESCAPE (Enhanced Smoking Cessation Approach to Promote Empowerment) protocol. This study will test a smoking cessation intervention using personal stories and a lung cancer screening decision-aide compared to standard care (brief advice, referral to a quit line, and a lung cancer screening decision-aide), examine the relationship between a polygenic risk score and smoking abstinence, and describe perceptions about integration of genomic information into smoking cessation treatment. A randomized controlled trial followed by a sequential explanatory mixed methods approach will compare the efficacy of the interventions. Interviews will add insight into the use of genomic information and risk perceptions to tailor smoking cessation treatment. Two-hundred and fifty individuals will be recruited from primary care, community-based organizations, mailing lists and through social media. Data will be collected at baseline, 1, 3 and 6-months. The primary outcomes are 7-day point prevalence smoking abstinence and stage of lung cancer screening at 6-months. The results from this study will provide information to refine the ESCAPE intervention and facilitate integration of precision health into future lung health interventions. Clinical trial registration number: NCT0469129T.
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Affiliation(s)
- Mary E Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, United States of America.
| | - Peter J Castaldi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, CLSB 11007, Boston, MA 02115, United States of America.
| | - Meghan Underhill Blazey
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, United States of America.
| | - Manan M Nayak
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, United States of America.
| | - Michael J Healey
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Christopher S Lathan
- Department of Medicine, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02115, United States of America.
| | | | - Rosanna F DeMarco
- Department of Nursing, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, United States of America.
| | - Sun S Kim
- Department of Nursing, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, United States of America.
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Li L, Ren Q, Zheng Q, Bai Y, He S, Zhang Y, Ma H. Causal associations between gastroesophageal reflux disease and lung cancer risk: A Mendelian randomization study. Cancer Med 2022; 12:7552-7559. [PMID: 36479899 PMCID: PMC10067102 DOI: 10.1002/cam4.5498] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Observational epidemiological studies suggest that lung cancer risk may be raised by gastroesophageal reflux disease (GERD); however, the causal relationship between them remains unknown. Our study performed the two-sample Mendelian randomization (MR) approach to examine the causal relationship between GERD and lung cancer. METHODS Instrument variables were found to be independent single nucleotide polymorphisms (SNPs) that were highly linked with GERD (n = 129,080). Summary data from genome-wide association studies (GWAS) data were used to determine outcomes for lung cancer (n = 11,348), squamous cell lung cancer (LUSC), and lung adenocarcinoma (LUAD). In this study, three MR statistical techniques (inverse variance weighted (IVW), MR-Egger, and weighted median) were used to examine the potential causative relationship between GERD and the risk of lung cancer. Cochran's Q test, MR-Egger intercept test, leave-one-out analysis, and the funnel plot were all used in sensitivity analyses. RESULTS The main IVW method revealed that GERD substantially increased the risk of lung cancer [odds ratio (OR) = 1.37; 95% CI 1.16-1.63, p = 0. 0003], which was also supported by weighted median and MR-Egger analyses. Using IVW estimate, similar causal relationships were also observed between GERD and LUSC (OR = 1.56; 95% CI 1.26-1.93, p = 5.35 × 10-5 ) and LUAD (OR = 1.45; 95% CI 1.09-1.93, p = 0.01). Although potential heterogeneity was observed in some studies, random effect IVW was not violated by the heterogeneity, indicating that the causal effect was robust. CONCLUSION GERD was positively associated with the risk of lung cancer, for LUSC and LUAD. This study shed light on a new direction for prevent strategy of lung cancer and therapeutic perspectives in patients with GERD.
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Affiliation(s)
- Lin Li
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
| | - Qiaoya Ren
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
| | - Qian Zheng
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
| | - Yuju Bai
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
| | - Sisi He
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
| | - Yu Zhang
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
| | - Hu Ma
- Department of Oncology The Second Affiliated Hospital of Zunyi Medical University Zunyi China
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Marshall HM, Vemula M, Hay K, McCaul E, Passmore L, Yang IA, Bowman RV, Fong KM. Active screening for lung cancer increases smoking abstinence in Australia. Asia Pac J Clin Oncol 2022; 19:374-384. [DOI: 10.1111/ajco.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Henry M. Marshall
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Mounavi Vemula
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute HerstonQueenslandAustralia
| | - Elizabeth McCaul
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Linda Passmore
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Ian A. Yang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Rayleen V. Bowman
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Kwun M. Fong
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
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Shelley D, Wang VHC, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022; 12:1076-1083. [PMID: 36227937 PMCID: PMC9677484 DOI: 10.1093/tbm/ibac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Based on the findings from the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends annual low dose computed tomography (LDCT) lung cancer screening (LCS) among high-risk adults. Approximately 54% of individuals seeking LCS report current cigarette smoking. Effective smoking cessation interventions, offered at the time of LCS, enhances the health benefits of screening that are attributable to reductions in lung cancer overall and tobacco-related mortality. Considering these data, the Centers for Medicare & Medicaid Services' (CMS) 2015 decision to cover LCS with LDCT required that radiology imaging facilities make tobacco cessation interventions available for people who smoke. In February 2022, CMS reversed their 2015 coverage requirement for delivering tobacco use treatment at the time of LDCT; CMS retained the requirement for counseling during the shared decision-making visit prior to the exam. The policy change does not diminish the importance of offering high-quality tobacco cessation services in conjunction with routine LDCT for LCS. However, LCS programs face a range of barriers to implementing tobacco use treatment in their settings. As a result, implementation has lagged. Closing the "evidence to practice" gap is the focus of implementation science, a field that offers a set of rigorous methods and a systematic approach to identifying and overcoming contextual barriers to implementing evidence-based guidelines in a range of clinical settings. In this paper, we describe how implementation science frameworks and methods can be used to help guide LCS programs in their efforts to integrate tobacco use treatment and discuss policy changes needed to further facilitate the delivery of TUT as an essential component of the LCS process.
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Affiliation(s)
- Donna Shelley
- NYU School of Global Public Health, New York, NY, USA
| | | | | | | | - Benjamin Toll
- Medical University of South Carolina, Charleston, SC, USA
| | - Alana Rojewski
- Medical University of South Carolina, Charleston, SC, USA
| | - Kristie L Foley
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Balata H, Quaife SL, Craig C, Ryan DJ, Bradley P, Crosbie PAJ, Murray RL, Evison M. Early Diagnosis and Lung Cancer Screening. Clin Oncol (R Coll Radiol) 2022; 34:708-715. [PMID: 36175244 DOI: 10.1016/j.clon.2022.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.
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Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - S L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Craig
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D J Ryan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - P Bradley
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R L Murray
- Academic Unit of Lifespan and Population Health, Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Roberts MC, Seaman EL, Klein WMP, Ferrer RA, Han PKJ, Katki HA, Land SR, Liotta RA, Nations JA, Peterson PG. Patient Perspectives on the Risk-Based NLST Outcomes Tool for Lung Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1438-1445. [PMID: 33686613 PMCID: PMC9190214 DOI: 10.1007/s13187-021-01977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
Researchers at the NCI have developed the Risk-Based NLST Outcomes Tool (RNOT), an online tool that calculates risk of lung cancer diagnosis and death with and without lung cancer screening, and false-positive risk estimates. This tool has the potential to facilitate shared decision making for screening. The objective of this study was to examine how current heavy and former smokers understand and respond to personalized risk estimates from the RNOT. Individuals who were eligible for lung cancer screening and were visiting Walter Reed National Military Medical Center were invited to participate in a semi-structured interview to assess their experiences with and perceptions of the RNOT. Results were analyzed using template analysis. Participants found their risk of lung cancer death to be lower than anticipated and were confused by changes in risk for lung cancer diagnosis with and without screening. Most participants indicated that the RNOT would be helpful in making screening decisions, despite reporting that there was no maximum risk for a false positive that would lead them to forgo lung cancer screening. Participants provided actionable needs and recommendations to optimize this tool. Risk-based screening tools may enhance shared decision making. The RNOT is being updated to incorporate these findings.
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Affiliation(s)
| | | | | | | | - Paul K J Han
- Maine Medical Center Research Institute, Scarborough, ME, USA
| | | | | | - Robert A Liotta
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joel A Nations
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - P Gabriel Peterson
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Begnaud A, Fu SS, Lindgren B, Melzer A, Rothman AJ, Schertz K, Vock DM, Joseph AM. Latent constructs identified in older individuals who smoke cigarettes and are eligible for lung cancer screening: Factor analysis of baseline data from the PLUTO smoking cessation trial. Contemp Clin Trials Commun 2022; 29:100977. [PMID: 36052176 PMCID: PMC9424922 DOI: 10.1016/j.conctc.2022.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Lung cancer screening (LCS) combined with smoking cessation intervention is currently recommended for older individuals with a history of heavy smoking. Tailoring tobacco treatment for this patient population of older, people who smoke (PWS) may improve cessation rates while efficiently using limited smoking cessation resources. Although some older people who smoke will need more intensive treatment to achieve sustained abstinence, others may be successful with less intensive treatment. A framework to identify them a priori would be helpful to distribute smoking cessation resources accordingly. Methods Baseline demographic, smoking, and health data are reported from a randomized clinical trial of longitudinal smoking cessation interventions delivered in the setting of LCS. Candidate variables were factor analyzed to identify latent factors, or constructs, to identify subgroups of older participants among the heterogenous population of older people who smoke. Results We identified three factor-derived constructs: self-reported health status, heaviness of smoking, and nicotine dependence. Nicotine dependence was moderately correlated with both of the other two factors. Conclusions This factor analysis of baseline participant characteristics identified a set of latent constructs – based on a few practical clinical variables -- that can be used to classify the heterogenous population of older people who smoke to identify. We propose this framework to identify subgroups of people who smoke who might successfully quit with less intense treatment at the time of lung cancer screening.
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Affiliation(s)
| | - Steven S Fu
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, USA
| | - Bruce Lindgren
- Masonic Cancer Center, Clinical and Translational Science Institute, USA
| | - Anne Melzer
- Pulmonary and Critical Care Medicine, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, USA
| | | | | | - David M Vock
- University of Minnesota School of Public Health, USA
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Eslani M, Nishida T, Weinreb RN, Baxter S, Mahmoudinezhad G, Kamalipour A, Yarmohammadi A, Zangwill LM, Moghimi S. Effects of Smoking on Optic Nerve Head Microvasculature Density in Glaucoma. J Glaucoma 2022; 31:710-716. [PMID: 35882030 PMCID: PMC9994055 DOI: 10.1097/ijg.0000000000002081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/24/2022] [Indexed: 01/22/2023]
Abstract
PRCIS Decreased superficial whole image capillary density was observed in open angle glaucoma (OAG) patients with high smoking intensity. PURPOSE To investigate the effects of smoking on optic nerve head capillary density measured by optical coherence tomography angiography in patients with OAG. METHODS In this retrospective cross-sectional study, perimetric and preperimetric glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with optical coherence tomography angiography follow-up were included. Univariable and multivariable linear mixed analysis were performed to determine the effects of different variables on the superficial whole image capillary density. RESULTS A total of 432 eyes of 271 glaucoma patients comprising 63 preperimetric (106 eyes) and 208 perimetric OAG (326 eyes) were included. A history of tobacco consumption was reported in 105 (38.8%). Among smokers, mean (95% confidence interval) smoking intensity was 12.8 (10.2, 15.5) pack-years. After adjusting for age, glaucoma severity and other confounders, each 10 pack-year increase in smoking intensity (95% confidence interval) was associated with -0.54 (-1.06, -0.02) % lower whole image capillary density ( P =0.041). CONCLUSIONS Smoking intensity is associated with reduced optic nerve vessel density in glaucoma.
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Affiliation(s)
- Medi Eslani
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Sally Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
- Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Adeleh Yarmohammadi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
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Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials 2022; 23:664. [PMID: 35978334 PMCID: PMC9383667 DOI: 10.1186/s13063-022-06568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread agreement that the integration of cessation services in lung cancer screening (LCS) is essential for achieving the full benefits of LCS with low-dose computed tomography (LDCT). There is a formidable knowledge gap about how to best design feasible, effective, and scalable cessation services in LCS facilities. A collective of NCI-funded clinical trials addressing this gap is the Smoking Cessation at Lung Examination (SCALE) Collaboration. METHODS The Cessation and Screening to Save Lives (CASTL) trial seeks to advance knowledge about the reach, effectiveness, and implementation of tobacco treatment in lung cancer screening. We describe the rationale, design, evaluation plan, and interventions tested in this multiphase optimization strategy trial (MOST). A total of 1152 screening-eligible current smokers are being recruited from 18 LCS sites (n = 64/site) in both academic and community settings across the USA. Participants receive enhanced standard care (cessation advice and referral to the national Quitline) and are randomized to receive additional tobacco treatment components (motivational counseling, nicotine replacement patches/lozenges, message framing). The primary outcome is biochemically validated, abstinence at 6 months follow-up. Secondary outcomes are self-reported smoking abstinence, quit attempts, and smoking reduction at 3 and 6 months. Guided by the Implementation Outcomes Framework (IOF), our evaluation includes measurement of implementation processes (reach, fidelity, acceptability, appropriateness, sustainability, and cost). CONCLUSION We will identify effective treatment components for delivery by LCS sites. The findings will guide the assembly of an optimized smoking cessation package that achieves superior cessation outcomes. Future trials can examine the strategies for wider implementation of tobacco treatment in LDCT-LCS sites. TRIAL REGISTRATION ClinicalTrials.gov NCT03315910.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Donna R Shelley
- School of Global Public Health, New York University, New York, USA
| | - Lou-Anne Chichester
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, D.C., USA
| | | | | | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Irene Orlow
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Sharon V Chan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Victoria Frederico
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Phillip Camille
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Jessica Kenney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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Taylor KL, Williams RM, Li T, Luta G, Smith L, Davis KM, Stanton C, Niaura R, Abrams D, Lobo T, Mandelblatt J, Jayasekera J, Meza R, Jeon J, Cao P, Anderson ED. A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting. J Natl Cancer Inst 2022; 114:1410-1419. [PMID: 35818122 DOI: 10.1093/jnci/djac127] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lung cancer mortality is reduced via low-dose CT screening and treatment of early-stage disease. Evidence-based smoking cessation treatment in the lung screening setting can further reduce mortality. We report the results of a cessation trial from the NCI's SCALE collaboration. METHODS Eligible patients (N = 818) aged 50-80 were randomized (May 2017-January 2021) to the Intensive vs. Minimal arms (8 vs. 3 phone sessions plus 8 vs. 2 weeks of nicotine patches, respectively). Bio-verified (primary) and self-reported 7-day abstinence rates were assessed 3-, 6-, and 12-months post-randomization. Logistic regression analyses evaluated the effects of study arm. All statistical tests were two-sided. RESULTS Participants reported 48.0 (SD = 17.2) pack-years and 51.6% were not ready to quit in < 30 days. Self-reported 3-month quit rates were significantly higher in the Intensive vs. Minimal arm (14.3% vs. 7.9%; OR = 2.00, 95% confidence interval [CI] = 1.26,3.18). Bio-verified abstinence was lower but with similar relative differences between arms (9.1% vs. 3.9%; OR = 2.70, 95% CI = 1.44, 5.08). Compared to the Minimal arm, the Intensive arm was more effective among those with greater nicotine dependence (OR = 3.47, 95% CI = 1.55, 7.76), normal screening results (OR = 2.58, 95% CI = 1.32, 5.03), high engagement in counseling (OR = 3.03, 95% CI = 1.50, 6.14) and patch use (OR = 2.81, 95% CI = 1.39, 5.68). Abstinence rates did not differ significantly between arms at 6-months (OR = 1.2, 95% CI = 0.68, 2.11) or 12-months (OR = 1.4, 95% CI = 0.82, 2.42). CONCLUSIONS Delivering intensive telephone counseling and nicotine replacement with lung screening is an effective strategy to increase short-term smoking cessation. Methods to maintain short-term effects are needed. Even with modest quit rates, integrating cessation treatment into lung screening programs may have a large impact on tobacco-related mortality.
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Affiliation(s)
- Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | | | - Raymond Niaura
- School of Global Public Health, New York University, NY, NY, USA
| | - David Abrams
- School of Global Public Health, New York University, NY, NY, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jeanne Mandelblatt
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jinani Jayasekera
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Eric D Anderson
- Department of Pulmonary and Sleep Medicine, Georgetown University Medical Center, Washington, DC, USA
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Cao P, Smith L, Mandelblatt JS, Jeon J, Taylor KL, Zhao A, Levy DT, Williams RM, Meza R, Jayasekera J. Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting. JNCI Cancer Spectr 2022; 6:pkac048. [PMID: 35818125 PMCID: PMC9382714 DOI: 10.1093/jncics/pkac048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are limited data on the cost-effectiveness of smoking cessation interventions in lung cancer screening settings. We conducted an economic analysis embedded in a national randomized trial of 2 telephone counseling cessation interventions. METHODS We used a societal perspective to compare the short-term cost per 6-month bio-verified quit and long-term cost-effectiveness of the interventions. Trial data were used to micro-cost intervention delivery, and the data were extended to a lifetime horizon using an established Cancer Intervention Surveillance and Modeling Network lung cancer model. We modeled the impact of screening accompanied by 8 weeks vs 3 weeks of telephone counseling (plus nicotine replacement) vs screening alone based on 2021 screening eligibility. Lifetime downstream costs (2021 dollars) and effects (life-years gained, quality-adjusted life-years [QALYs]) saved were discounted at 3%. Sensitivity analyses tested the effects of varying quit rates and costs; all analyses assumed nonrelapse after quitting. RESULTS The costs for delivery of the 8-week vs 3-week protocol were $380.23 vs $144.93 per person, and quit rates were 7.14% vs 5.96%, respectively. The least costly strategy was a 3-week counseling approach. An 8-week (vs 3-week) counseling approach increased costs but gained QALYs for an incremental cost-effectiveness ratio of $4029 per QALY. Screening alone cost more and saved fewer QALYs than either counseling strategy. Conclusions were robust in sensitivity analyses. CONCLUSIONS Telephone-based cessation interventions with nicotine replacement are considered cost-effective in the lung screening setting. Integrating smoking cessation interventions with lung screening programs has the potential to maximize long-term health benefits at reasonable costs.
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Affiliation(s)
- Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Laney Smith
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Kathryn L Taylor
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Amy Zhao
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - David T Levy
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Randi M Williams
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jinani Jayasekera
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Lowenstein LM, Nishi SPE, Lopez-Olivo MA, Crocker LC, Choi N, Kim B, Shih YCT, Volk RJ. Smoking cessation services and shared decision-making practices among lung cancer screening facilities: A cross-sectional study. Cancer 2022; 128:1967-1975. [PMID: 35157302 DOI: 10.1002/cncr.34145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little is known about how screening facilities are meeting the requirements for the reimbursement of lung cancer screening from the Centers for Medicare & Medicaid Services (CMS), including 1) the collection and submission of data to the CMS-approved registry (American College of Radiology [ACR] Lung Cancer Screening Registry), 2) the verification of a counseling and shared decision-making (SDM) visit having occurred as part of the written order for lung cancer screening with low-dose computed tomography, and 3) the offering of smoking cessation interventions. METHODS The authors identified facilities in a southwestern state that were listed by either the ACR Lung Cancer Screening Registry or the GO2 Foundation Centers of Excellence. To select facilities, they used 2 purposive sampling approaches: maximum variation sampling and snowball sampling. They surveyed facilities from February to November 2019. RESULTS There were 87 facilities contacted, and a total of 63 facilities representing 32 counties across Texas completed the survey. Nearly all facilities used Lung-RADS to classify nodules (92%; n = 58) and submitted data to a CMS-approved registry (92%; n = 57). Most facilities verified that the counseling and SDM visit had occurred (86%; n = 54). Although slightly more than half of the facilities reported always providing self-help cessation materials (68%; n = 42), similar or higher proportions of facilities reported that they never referred smokers to onsite cessation services (68%; n = 42) or quitlines (77%; n = 47), provided cessation counseling (81%; n = 50), or recommended medications (85%; n = 52). CONCLUSIONS In general, screening facilities are meeting CMS requirements for screening, but they are struggling to offer smoking cessation interventions other than providing self-help materials.
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Affiliation(s)
- Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shawn P E Nishi
- Division of Pulmonary and Critical Care Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura Covarrubias Crocker
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Noah Choi
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,University of California San Diego Medical School, La Jolla, California
| | - Bumyang Kim
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Milken Institute, Santa Monica, California
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Bold KW, Cannon S, Ford BB, Neveu S, Sather P, Toll BA, Fucito LM. Examining Tobacco Treatment Perceptions and Barriers among Black versus Non-Black Adults Attending Lung Cancer Screening. Cancer Prev Res (Phila) 2022; 15:327-333. [PMID: 35063942 PMCID: PMC9064926 DOI: 10.1158/1940-6207.capr-21-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
Abstract
The US Preventive Services Task Force recommends annual lung cancer screening for patients at high risk based on age and smoking history. Understanding the characteristics of patients attending lung cancer screening, including potential barriers to quitting smoking, may inform ways to engage these high-risk patients in tobacco treatment and address health disparities. Patients attending lung cancer screening who currently smoke cigarettes completed a survey at Smilow Cancer Hospital at Yale-New Haven (N = 74) and the Medical University of South Carolina (N = 73) at the time of their appointment. The survey assessed demographics, smoking history, and perceptions and concerns about quitting smoking. Patients were 55 to 76 years old (mean = 63.3, SD = 5.3), N = 64 (43.5%) female, and N = 31 (21.1%) non-Hispanic Black. Patients smoked 16.3 cigarettes per day on average (SD = 9.2) and rated interest in quitting smoking in the next month as moderate (mean = 5.6, SD = 3.1, measured from 0 = "very definitely no" to 10 = "very definitely yes"). The most frequently endorsed concerns about quitting smoking were missing smoking (70.7%), worry about having strong urges to smoke (63.9%), and concerns about withdrawal symptoms (59.9%). In comparison with other races/ethnicities, Black patients were less likely to report concerns about withdrawal symptoms and more likely to report smoking less now and perceiving no need to quit. Findings identified specific barriers for tobacco treatment and differences by race/ethnicity among patients attending lung cancer screening, including concerns about withdrawal symptoms and perceived need to quit. Identifying ways to promote tobacco treatment is important for reducing morbidity and mortality among this high-risk population. PREVENTION RELEVANCE The current study examines patient characteristics and tobacco treatment perceptions and barriers among patients attending lung cancer screening who continue to smoke cigarettes that may help inform ways to increase treatment engagement and address tobacco-related health disparities to reduce morbidity and mortality from smoking.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Sydney Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Bennie B Ford
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Susan Neveu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Polly Sather
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin A Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
- Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
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40
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Heffner JL, Coggeshall S, Wheat CL, Krebs P, Feemster LC, Klein DE, Nici L, Johnson H, Zeliadt SB. Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration. J Gen Intern Med 2022; 37:1704-1712. [PMID: 34282533 PMCID: PMC9130430 DOI: 10.1007/s11606-021-07011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. OBJECTIVE To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key Results Of the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. CONCLUSIONS One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.
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Affiliation(s)
- Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA, USA.
| | - Scott Coggeshall
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
| | - Chelle L Wheat
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
| | - Paul Krebs
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Laura C Feemster
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | | | - Linda Nici
- Providence VA Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Hannah Johnson
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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Grover H, King W, Bhattarai N, Moloney E, Sharp L, Fuller L. Systematic review of the cost-effectiveness of screening for lung cancer with low dose computed tomography. Lung Cancer 2022; 170:20-33. [DOI: 10.1016/j.lungcan.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/23/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
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Darville A, Rademacher K, Wiggins AT, Lenhof MG, Hahn EJ. Training Tobacco Treatment Specialists through Virtual Asynchronous Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3201. [PMID: 35328889 PMCID: PMC8955214 DOI: 10.3390/ijerph19063201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.
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Affiliation(s)
- Audrey Darville
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (K.R.); (A.T.W.); (M.G.L.); (E.J.H.)
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Williams RM, Cordon M, Eyestone E, Smith L, Luta G, McKee BJ, Regis SM, Abrams DB, Niaura RS, Stanton CA, Parikh V, Taylor KL. Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment. Cancer 2022; 128:1976-1986. [PMID: 35143041 PMCID: PMC9038674 DOI: 10.1002/cncr.34133] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes. METHODS In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). RESULTS Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). CONCLUSIONS During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.
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Affiliation(s)
- Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Marisa Cordon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Brady J McKee
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shawn M Regis
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David B Abrams
- New York University School of Global Public Health, New York, New York
| | - Raymond S Niaura
- New York University School of Global Public Health, New York, New York
| | | | - Vicky Parikh
- Department of Population Health, MedStar Shah Medical Group, Hollywood, Maryland
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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Buttery SC, Williams P, Mweseli R, Philip KEJ, Sadaka A, Bartlett EJ, Devaraj A, Kemp S, Addis J, Derbyshire J, Chen M, Morris K, Laverty A, Hopkinson NS. Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial. BMJ Open Respir Res 2022; 9:9/1/e001030. [PMID: 35121633 PMCID: PMC8819808 DOI: 10.1136/bmjresp-2021-001030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/16/2022] [Indexed: 12/22/2022] Open
Abstract
Objectives Lung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screening programme, increases quit rates compared to usual care (Very Brief Advice to quit and signposting to smoking cessation services). Materials and methods We conducted a single-blind randomised controlled trial of current smokers aged 55–75 years attending a Targeted Lung Health Check. On randomly allocated days smokers received either (1) immediate support from a trained smoking cessation counsellor with appropriate pharmacotherapy or (2) usual care. The primary outcome was self-reported quit rate at 3 months. We performed thematic analysis of participant interview responses. Results Of 412 people attending between January and March 2020, 115 (27.9%) were current smokers; 46% female, mean (SD) 62.4 (5.3) years. Follow-up data were available for 84 smokers. At 3 months, quit rates in the intervention group were higher 14/48 (29.2%) vs 4/36 (11%) (χ2 3.98, p=0.04). Participant interviews revealed four smoking-cessation related themes: (1) stress and anxiety, (2) impact of the COVID-19 pandemic, (3) CT scans influencing desire to quit and (4) individual beliefs about stopping smoking. Conclusion The provision of immediate smoking cessation support is associated with a substantial increase in quit rates at 3 months. Further research is needed to investigate longer-term outcomes and to refine future service delivery. Trial registration number ISRCTN12455871.
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Affiliation(s)
- Sara C Buttery
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - Parris Williams
- Imperial College London, London, UK .,National Heart and Lung Institute, Imperial College London, London, UK.,NHLI Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Rebecca Mweseli
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Keir Elmslie James Philip
- Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,NHLI Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ahmed Sadaka
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Radiology, Royal Brompton Hospital, London, UK
| | - Samual Kemp
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jamie Addis
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | | | - Anthony Laverty
- Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - Nicholas S Hopkinson
- Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,NHLI Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Kohn R, Vachani A, Small D, Stephens-Shields AJ, Sheu D, Madden VL, Bayes BA, Chowdhury M, Friday S, Kim J, Gould MK, Ismail MH, Creekmur B, Facktor MA, Collins C, Blessing KK, Neslund-Dudas CM, Simoff MJ, Alleman ER, Epstein LH, Horst MA, Scott ME, Volpp KG, Halpern SD, Hart JL. Comparing Smoking Cessation Interventions among Underserved Patients Referred for Lung Cancer Screening: A Pragmatic Trial Protocol. Ann Am Thorac Soc 2022; 19:303-314. [PMID: 34384042 PMCID: PMC8867367 DOI: 10.1513/annalsats.202104-499sd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023] Open
Abstract
Smoking burdens are greatest among underserved patients. Lung cancer screening (LCS) reduces mortality among individuals at risk for smoking-associated lung cancer. Although LCS programs must offer smoking cessation support, the interventions that best promote cessation among underserved patients in this setting are unknown. This stakeholder-engaged, pragmatic randomized clinical trial will compare the effectiveness of four interventions promoting smoking cessation among underserved patients referred for LCS. By using an additive study design, all four arms provide standard "ask-advise-refer" care. Arm 2 adds free or subsidized pharmacologic cessation aids, arm 3 adds financial incentives up to $600 for cessation, and arm 4 adds a mobile device-delivered episodic future thinking tool to promote attention to long-term health goals. We hypothesize that smoking abstinence rates will be higher with the addition of each intervention when compared with arm 1. We will enroll 3,200 adults with LCS orders at four U.S. health systems. Eligible patients include those who smoke at least one cigarette daily and self-identify as a member of an underserved group (i.e., is Black or Latinx, is a rural resident, completed a high school education or less, and/or has a household income <200% of the federal poverty line). The primary outcome is biochemically confirmed smoking abstinence sustained through 6 months. Secondary outcomes include abstinence sustained through 12 months, other smoking-related clinical outcomes, and patient-reported outcomes. This pragmatic randomized clinical trial will identify the most effective smoking cessation strategies that LCS programs can implement to reduce smoking burdens affecting underserved populations. Clinical trial registered with clinicaltrials.gov (NCT04798664). Date of registration: March 12, 2021. Date of trial launch: May 17, 2021.
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Affiliation(s)
- Rachel Kohn
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
| | | | - Dylan Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Jannie Kim
- Palliative and Advanced Illness Research Center
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Beth Creekmur
- Department of Research and Evaluation, Kaiser Permanente Southern California, Riverside, California
| | | | | | - Kristina K. Blessing
- Investigator Initiated Research Operations, Geisinger Health System, Danville, Pennsylvania
| | | | - Michael J. Simoff
- Henry Ford Cancer Institute, and
- Department of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan
| | | | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michael A. Horst
- Lancaster General Health Research Institute, University of Pennsylvania Health System, Lancaster, Pennsylvania
| | - Michael E. Scott
- The Center for Black Health and Equity, Durham, North Carolina; and
| | - Kevin G. Volpp
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Scott D. Halpern
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Biostatistics, Epidemiology and Informatics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L. Hart
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Quaife SL, Brain KE, Stevens C, Kurtidu C, Janes SM, Waller J. Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS). Psychol Health 2022; 37:194-210. [PMID: 33593154 PMCID: PMC12097803 DOI: 10.1080/08870446.2021.1879806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake. METHODS Leventhal's Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55-80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs' associations with screening intention, smoking status and demographics. RESULTS The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach's alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p's < .05). CONCLUSIONS The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.
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Affiliation(s)
- Samantha L. Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kate E. Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Claire Stevens
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Clara Kurtidu
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
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Kukhareva PV, Caverly TJ, Li H, Katki HA, Cheung LC, Reese TJ, Del Fiol G, Hess R, Wetter DW, Zhang Y, Taft TY, Flynn MC, Kawamoto K. OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:779-788. [PMID: 35167675 PMCID: PMC9006678 DOI: 10.1093/jamia/ocac020] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/14/2022] Open
Abstract
Objective Materials and Methods Results Discussion Conclusion
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Affiliation(s)
- Polina V Kukhareva
- Corresponding Author: Polina V. Kukhareva, PhD, MPH, Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 108, Salt Lake City, UT 84108, USA;
| | - Tanner J Caverly
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Haojia Li
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Li C Cheung
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Yue Zhang
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Y Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
- Community Physicians Group, University of Utah Health, Salt Lake City, Utah, USA
- Community Physicians Group, University of Utah, Salt Lake City, UT, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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Salloum RG, Braithwaite D. Expansion of Guideline-Recommended Lung Cancer Screening Eligibility: Implications for Health Equity of Joint Screening and Cessation Interventions. J Thorac Oncol 2022; 17:13-15. [PMID: 34930605 DOI: 10.1016/j.jtho.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida; Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville, Florida.
| | - Dejana Braithwaite
- Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville, Florida; Department of Epidemiology, University of Florida, Gainesville, Florida
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Impact of Joint Lung Cancer Screening and Cessation Interventions Under the New Recommendations of the U.S. Preventive Services Task Force. J Thorac Oncol 2022; 17:160-166. [PMID: 34648947 PMCID: PMC8692396 DOI: 10.1016/j.jtho.2021.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In 2021, the U.S. Preventive Services Task Force (USPSTF) revised its lung cancer screening recommendations expanding its eligibility. As more smokers become eligible, cessation interventions at the point of screening could enhance the benefits. Here, we evaluate the effects of joint screening and cessation interventions under the new recommendations. METHODS A validated lung cancer natural history model was used to estimate lifetime number of low-dose computed tomography screens, percentage ever screened, lung cancer deaths, lung cancer deaths averted, and life-years gained for the 1960 U.S. birth cohort aged 45 to 90 years (4.5 million individuals). Screening occurred according to the USPSTF 2013 and 2021 recommendations with varying uptake (0%, 30%, 100%), with or without a cessation intervention at the point of screening with varying effectiveness (15%, 100%). RESULTS Screening 30% of the eligible population according to the 2021 criteria with no cessation intervention (USPSTF 2021, 30% uptake, without cessation intervention) was estimated to result in 6845 lung cancer deaths averted and 103,725 life-years gained. These represent 28% and 34% increases, respectively, relative to screening according to the 2013 guidelines (USPSTF 2013, 30% uptake, without cessation intervention). Adding a cessation intervention at the time of the first screen with 15% effectiveness (USPSTF 2021, 30% uptake, with cessation intervention with 15% effectiveness) was estimated to result in 2422 additional lung cancer deaths averted (9267 total, ∼73% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 322,785 life-years gained (∼318% increase). Screening 100% of the eligible according to the 2021 guidelines with no cessation intervention (USPSTF 2021, 100% uptake, without cessation intervention) was estimated to result in 23,444 lung cancer deaths averted (∼337% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 354,330 life-years gained (∼359% increase). Adding a cessation intervention with 15% effectiveness (USPSTF 2021, 100% uptake, with cessation intervention with 15% effectiveness) would result in 31,998 lung cancer deaths averted (∼497% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 1,086,840 life-years gained (∼1309% increase). CONCLUSIONS Joint screening and cessation interventions would result in considerable lung cancer deaths averted and life-years gained. Adding a one-time cessation intervention of modest effectiveness (15%) results in comparable life-years gained as increasing screening uptake from 30% to 100% because while cessation decreases mortality from many causes, screening only reduces lung cancer mortality. This simulation indicates that incorporating cessation programs into screening practice should be a priority as it can maximize overall benefits.
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50
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Roughgarden KL, Toll BA, Tanner NT, Frazier CC, Silvestri GA, Rojewski AM. Tobacco Treatment Specialist Training for Lung Cancer Screening Providers. Am J Prev Med 2021; 61:765-768. [PMID: 34226091 PMCID: PMC8541897 DOI: 10.1016/j.amepre.2021.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/26/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Kelly L Roughgarden
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Benjamin A Toll
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Nichole T Tanner
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina; Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Cassie C Frazier
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Gerard A Silvestri
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina; Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Alana M Rojewski
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
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