Study finds chances of quitting smoking improve with integrated care, including medication and counseling

Smokers undergoing lung cancer screening may have the best chance of quitting if they receive integrated care, which includes medication and comprehensive counseling with tobacco treatment specialists, according to researchers at The University of Texas MD Anderson Cancer Center.

The study results, published in JAMA Internal Medicine, demonstrate that integrated care outperformed other cessation methods with a nearly two-fold improvement in the odds of quitting.

In this randomized clinical trial of 630 current smokers who were eligible for lung cancer screening, over 30% of those who received integrated care were still abstaining from smoking after six months.

“For those who smoke, lung cancer screening presents a critical opportunity for us to support them in quitting,” said principal investigator Paul Cinciripini, Ph.D., chair of Behavioral Science and executive director of the Tobacco Research and Treatment Program at MD Anderson.

“Our study demonstrates that providing access to effective medications and trained tobacco cessation specialists offers the greatest chance at successfully quitting and, hopefully, avoiding the potential of lung cancer.”

Lung cancer is the leading cause of cancer mortality in the U.S. and the second most diagnosed cancer, accounting for one in five cancer-related deaths. Tobacco use is responsible for 85% of lung cancer cases and contributes to nearly 30% of all cancer-related deaths. Each year, an estimated 480,000 Americans die from tobacco-related illnesses.

The average smoker makes several attempts to quit before successfully beating the addiction. MD Anderson’s Tobacco Research and Treatment Program tackles the barriers to cessation at an individual and population level, and its scientists conduct research designed to change clinical practice by addressing knowledge gaps among health care providers treating tobacco addiction.

In this study, participants were recruited from Houston between July 2017-2021. They were at least 50 years old and smoked a median of 20 cigarettes per day.

The participants were randomized into three groups of 210, receiving the following interventions: a quitline referral and nicotine replacement therapy (NRT) (QL); a quitline referral plus NRT or medication prescribed by a lung cancer screening clinician (QL+); or integrated care (IC), which included NRT or prescription pharmacotherapy and counseling, provided by a team of tobacco treatment specialists and physicians.

At the three-month mark, IC had the highest quit rate, 37.1%, compared to 27.1% in the QL+ and 25.2% in the QL cohorts. At the six-month mark, IC maintained the highest quit rate, 32.4%, compared to 27.6% for the QL+ group and 20.5% for the QL group.

“Facilities equipped to provide dedicated and integrated care should prioritize doing so to offer patients the best opportunity for smoking cessation and improved health outcomes,” Cinciripini said.

“Given our results, it is conceivable that this approach could also be highly effective outside a screening environment, such as post-traumatic stress clinics and among patients with cancer, cardiovascular disease or diabetes.”

Limitations of this study include that the population was predominately white, and that the entire sample lacked CO (expired carbon monoxide) abstinence verification due to COVID restrictions after the study had begun, although overall results between sub-samples with and without verification were similar.