The Yorkshire Enhanced Stop Smoking (YESS) Study: personalised smoking cessation support in a lung cancer screening program

To date, many patients who undergo lung cancer screening continue to smoke. Although screening may offer a teachable moment for smoking cessation (SC), there is little data on how to implement SC. Results from the Yorkshire Enhanced Stop Smoking (YESS) Study demonstrated that patients with lung cancer who attended a lung cancer screening event and who then participated in a personalised smoking cessation study achieved smoking abstinence rates of more than 30%.

Low-dose computed tomography (LDCT) screening for lung cancer was approved in the US in 2013, and other nations are in various stages of implementation. Unfortunately, many participants in lung cancer screening (LCS) continue to smoke. Although LCS offers a teachable moment for smoking cessation (SC), the optimal way to implement this is unclear. Evidence from other settings highlights the effectiveness of personalised risk information when used as part of a SC intervention.

Study Design

 In the Yorkshire Lung Screening Trial, co-located SC support was offered on an opt-out basis to all eligible smokers attending for a lung health check (LHC) including LDCT screening. SC support comprised nicotine replacement therapy/e-cigarettes/varenicline/bupropion and behavioural support. Further, four weeks following their LHC, participants were offered recruitment to the Yorkshire Enhanced Stop Smoking (YESS) trial, a double-blind randomised controlled trial of an enhanced, personalised SC support package including a booklet containing CT images of the participants’ own heart and lungs, annotated where appropriate to highlight emphysema or coronary artery calcification (CAC) with accompanying explanatory text, and scripted behavioural support delivered by a trained smoking cessation practitioner (SCP), compared to continued standard best practice. The primary outcome is 7-day point prevalent (PP) carbon monoxide (CO) validated cessation 3-months after the LHC (and thus 2-months after recruitment into YESS). Secondary outcomes include CO validated cessation at 4-weeks and 12-months, and self-reported cessation at 4-weeks, 3-months and 12-months following the LHC.

Results

During a lung health check event, 2,150 people who reported a history of smoking were offered the opportunity to see a smoking cessation professional. Of them, 1,905 (88.6%) accepted the referral and 1,609 accepted ongoing support. The seven-day validated abstinence rate in those accepting support was 16.5% as measured four weeks after the lung health check event (12.4% of all eligible smokers). Of those who attended the lung health check event, 1,003 smokers participated in the YESS trial (mean age 65 years, 50% male, 96% White, 39% in the lowest deprivation quintile). In total, 52.5% of these smokers were allocated to the intervention group. There were no baseline differences between study groups.

The validated 7-day point prevalence abstinence rates were 33.6% in the intervention group and 30.0% in the control group (unadjusted OR 1.17, 95%CI: 0.90-1.54, p= 0.229) at three months post-LHC and 29.2% and 28.6% (unadjusted OR 1.03, 95%CI: 0.78-1.36, p= 0.82) at twelve months post-LHC. Subgroup analyses indicated a significant gender interaction at both three and twelve months (p= 0.002 and p= 0.011 respectively), with the intervention being most effective in females (three-months abstinence rates among female participants were 33.9% in the intervention vs. 23.1% in the control, unadjusted OR 1.70, 95%CI: 1.15-2.53, p= 0.008). There was no significant effect of booklet content (presence/absence of emphysema or CAC) on quit rates.

Conclusion

The presence of a co-located stop smoking service and offer of immediate, opt-out delivery of behavioural and pharmacological support for quitting results in a high uptake by people who smoke attending for a LHC. Around one third of the patients quit at three months, and this was largely sustained to twelve months. The intervention seems to be mainly effective in females. Quit rates were considerably higher 3-months post-LHC, regardless of adding the personalised intervention, reinforcing the need for continued support. Further research is needed as to the efficacy of providing personalised lung and heart health information in addition to best practice SC support.

Reference

Murray RL, Brain K, Britton J, et al. Personalised Smoking Cessation Support in a Lung Cancer Screening Programme: The Yorkshire Enhanced Stop Smoking Study (YESS). Presented at IASLC WCLC 2022; Abstract PL03.03.