Laura Litwin

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An integrated care model of medication and intensive counseling was found to be the best treatment strategy for smoking cessation in the lung cancer screening (LCS) setting among those who currently smoke, according to results published in JAMA Internal Medicine.A team of researchers from the University of Texas MD Anderson Cancer Center, led by Paul M. Cinciripini, PhD, conducted the randomized clinical trial &ldquo;to evaluate the efficacy of 3 tobacco treatment strategies of increasing integration and intensity in the LCS setting.&rdquo; The study was performed from July 2017 to June 2022 at a hospital-based tobacco treatment clinic in Houston, Texas.Patients who were eligible for LCS included individuals who currently smoke. They were randomized into 3 treatment groups of 210 participants each as part of the trial, which included a quitline cohort, a quitline plus cohort, and an integrated care cohort.The quitline group interventions were quitline referral and a 12-week nicotine replacement therapy (NRT) program. In the quitline plus group, interventions included quitline referral plus a 12-week NRT program or &ldquo;pharmacotherapy prescribed by the LCS clinician.&rdquo; The integrated care group received a 12-week NRT program or prescription pharmacotherapy and counseling &ldquo;provided by tobacco treatment specialists within the LCS health care environment.&rdquo;The investigators explained that, during the trial, they altered the primary study outcome from &ldquo;biochemically verified 7-day point prevalence abstinence at 6 months&rdquo; to self-reported abstinence due to restrictions put in place during the COVID-19 pandemic.A total of 630 patients participated in the trial, including 320 (58%) who were male, and the median age was 59 years. The median number of cigarettes smoked per day among participants was 20. For the quitline and quitline plus groups, the median number of counseling sessions was 4, and for the integrated care group, the median number of counseling sessions was 8.Abstinence was reviewed at 3 months and 6 months. At 3 months, 53 participants (25.2%) in the quitline cohort and 57 participants (27.1%) in the quitline plus cohort reported abstinence, while 78 of those (37.1%) in the integrated care cohort reported abstinence. The researchers noted that, at this timepoint, the integrated care group &ldquo;outperformed&rdquo; both quitline (odds ratio [OR], 1.75 [95% CI, 1.15-2.66]; P =.01) and quitline plus (OR, 1.58 [95% CI, 1.05-2.40]; P = .03).Abstinence remained highest in the integrated care cohort at the timepoint of 6 months as well. Sixty-eight individuals (32.4%) in the integrated care group, 58 (27.6%) in the quitline plus group, and 43 (20.5%) in the quitline group reported abstinence. The researchers also highlighted that at the 6-month point, integrated outperformed quitline only.The investigators conducted a Bayesian analysis, which revealed that the integrated care group &ldquo;demonstrated a higher probability of positive absolute risk differences (ARDs) in abstinence at 3 months&rdquo; versus quitline (ARD, 0.12) &ldquo;with 99% probability of positive ARD,&rdquo; and quitline plus (ARD, 0.10) &ldquo;with 98% probability of positive ARD.&rdquo; They reported the same advantage was found at the 6-month point as well, with ARDs of 0.12 for the quitline group and 0.05 for the quitline plus group (99% positive ARD probability and 86% positive ARD probability, respectively.)According to the results, the integrated care intervention, which involved medication and intensive counseling, provided the best smoking cessation outcomes for patients when compared with the quitline referral intervention &ldquo;with or without LCS clinician-managed medication.&rdquo; However, the researchers concluded that because performance differences in the quitline plus group were reduced at 6 months, the quitline plus intervention &ldquo;could be considered in low-resource settings.&rdquo;ReferenceCinciripini P, Minnix J, Kypriotakis G, et al. Smoking cessation interventions in the lung cancer screening setting: a randomized clinical trial. JAMA Intern Med. 2025;185(3):284-291. doi:10.1001/jamainternmed.2024.7288

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Integrated Care: Optimal Smoking Cessation Interventions in Lung Cancer Screening Settings

Integrated interventions involving medication and intensive counseling provided the best smoking cessation outcomes for patients when compared with quitline referrals alone.

How Integrated Interventions Promote Smoking Cessation in Patients Who Currently Smoke