C30 LUNG CANCER SCREENING: WHO, WHY, WHERE, AND HOW MUCH: Integrating Smoking Cessation Counseling And Treatment In A Lung Cancer Screening Program: An Effective Approach To Long-Term Smoking Cessation Success

Publication Title

Am J Respir Crit Care Med

Document Type

Conference Proceeding

Publication Date

5-23-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Introduction: Cigarette smoke exposure contributes to 80-90% of lung cancers. Given this, and the dismal 4-7% national smoking cessation quit rates, the Centers for Medicare and Medicaid Services require that smoking cessation is addressed within the setting of lung cancer screening; however, variation in interpretation and implementation of such services exist. Combination counseling and evidence-based pharmacologic treatments yield the highest potential for long-term quit success in smoking cessation. We aimed to assess quit success in follow-up, for high-risk patients enrolled in our lung cancer screening program who received direct smoking cessation services. Methods: Swedish Lung Cancer Screening and Tobacco Related Diseases Program is led by dedicated Advanced Registered Nurse Practitioners (ARNPs) who possess prescriptive privileges and are Certified Tobacco Treatment Specialists (CTTS). This novel screening model includes an in-person medical evaluation, review of CT scan, smoking cessation counseling and treatment services. This begins with the Shared Decision Making visit and occurs at each subsequent face-to-face screening encounter. On the initial visit, smoking history is obtained, counseling is provided using the Motivational Interviewing for Behavior Change paradigm, and a personalized pharmacologic treatment plan is prescribed, if the patient is interested and willing. A continuum of smoking cessation counseling and medication management is provided telephonically following the screening visit, and in subsequent in-person screening visits for as long as the patient is smoking. We retrospectively reviewed 263 patients from November 01, 2012 to March 01, 2016, who were identified as smoking at any time during their enrollment in the lung cancer screening program, with the purpose of assessing their quit status on subsequent follow-up. Results: Of the 263 patients, 174 had at least two contacts with the ARNP/CTTS (initial screening visit and one follow-up screening visit or smoking cessation specific telephonic encounter). We observed a continued improvement in smoking cessation rates during the period of observation with 43% (74/174) who had a documented quit status at the last documented visit, at a median of 13 months follow-up (interquartile range: 6-19 months) [Table]. Conclusion: Lung cancer screening is a teachable moment and a viable opportunity to capture a high-risk population while directly influencing smoking as a modifiable behavior and cancer risk. We identified that through the integration and provision of direct smoking cessation and treatment services by a dedicated ARNP/CTTS, within the continuum of lung cancer screening, we can positively influence smoking cessation with a greater potential for meaningful long-term quit success.

Clinical Institute

Cancer

Clinical Institute

Mental Health

Specialty

Oncology

Specialty

Pulmonary Medicine

Specialty

Behavioral Health

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