Readiness and capacity of US lung cancer screening sites to deliver tobacco dependence treatment

Introduction: The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality in a high risk population of heavy smokers who underwent three yearly, low dose helical CT scans of the chest. Lung cancer screening provides an unprecedented opportunity to reach smokers and deliver evidence-based smoking cessation interventions. However, little is known about the current state of integrating tobacco use treatment (TUT) into screening protocols. In order to guide development of a planned trial to disseminate and implement PHS clinical practice guidelines for treating tobacco use and dependence into screening settings, we have begun collecting pilot data on screening sites’ readiness and capacity to deliver evidence-based tobacco cessation treatment.

Methods:  We are conducting a survey of TUT attitudes and practices at 150 lung cancer screening sites. Survey respondents include oncologists, radiologists, oncology nurses and nurse practitioners.

Results: Thus far, data has been collected from eight screening sites. Preliminary data shows that while practitioners at screening sites endorse the importance of providing TUT, actual delivery of TUT remains suboptimal in screening settings. Barriers to delivery include lack of sufficient knowledge of the PHS guidelines for TUT, lack of time, lack of reimbursement for services, and lack of institutional support.  

Conclusions:  Our findings underscore the importance of raising awareness of the PHS Guidelines and further evaluating barriers to tobacco use treatment in lung cancer screening sites. This study will  provide a baseline benchmark for subsequent dissemination and implementation efforts to integrate tobacco cessation treatment into routine lung cancer screening.