Fucito Lisa M, Czabafy Sharon, Hendricks Peter S, Kotsen Chris, Richardson Donna, Toll Benjamin A
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut.
Cancer. 2016 Apr 15;122(8):1150-9. doi: 10.1002/cncr.29926. Epub 2016 Feb 24.
Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation.
戒烟对于降低癌症风险和过早死亡率至关重要。美国预防服务工作组(USPSTF)建议每年进行低剂量计算机断层扫描(LDCT)肺癌筛查,医疗保险和医疗补助服务中心最近批准将肺癌筛查作为一项福利提供给有30包年吸烟史的55至77岁患者。尼古丁与烟草研究学会(SRNT)和烟草使用与依赖治疗协会(ATTUD)基于一项说明性文献综述制定了本评论中所述的指南,以展示该高危人群戒烟对健康有益的证据,并为将循证戒烟治疗与肺癌筛查相结合提供临床建议。遗憾的是,在撰写本指南时,关于肺癌筛查参与者的现有数据很少。然而,在本综述中,作者总结了关于戒烟益处以及55至77岁吸烟者戒烟干预效果的充分证据,以便为寻求肺癌筛查的吸烟者提供戒烟干预。结论是,前来进行肺癌筛查的吸烟者每次就诊时都应被鼓励戒烟。无论扫描结果如何,都应为所有吸烟者提供循证戒烟干预措施,且戒烟动机不应成为治疗的必要前提条件。应为吸烟者安排后续随访以支持其戒烟努力。每次就诊时都应采用循证行为策略来激励那些不愿尝试戒烟/减少吸烟或尝试可能最终导致戒烟的循证治疗的吸烟者。