1 Department of Medicine.
2 Department of Psychology.
Am J Respir Crit Care Med. 2018 Jan 15;197(2):172-182. doi: 10.1164/rccm.201705-0909CI.
National recommendations for lung cancer screening for former and current smokers aged 55-80 years with a 30-pack-year smoking history create demand to implement efficient and effective systems to offer smoking cessation on a large scale. These older, high-risk smokers differ from participants in past clinical trials of behavioral and pharmacologic interventions for tobacco dependence. There is a gap in knowledge about how best to design systems to extend reach and treatments to maximize smoking cessation in the context of lung cancer screening. Eight clinical trials, seven funded by the National Cancer Institute and one by the Veterans Health Administration, address this gap and form the SCALE (Smoking Cessation within the Context of Lung Cancer Screening) collaboration. This paper describes methodological issues related to the design of these clinical trials: clinical workflow, participant eligibility criteria, screening indication (baseline or annual repeat screen), assessment content, interest in stopping smoking, and treatment delivery method and dose, all of which will affect tobacco treatment outcomes. Tobacco interventions consider the "teachable moment" offered by lung cancer screening, how to incorporate positive and negative screening results, and coordination of smoking cessation treatment with clinical events associated with lung cancer screening. Unique data elements, such as perceived risk of lung cancer and costs of tobacco treatment, are of interest. Lung cancer screening presents a new and promising opportunity to reduce morbidity and mortality resulting from lung cancer that can be amplified by effective smoking cessation treatment. SCALE teamwork and collaboration promise to maximize knowledge gained from the clinical trials.
国家建议为年龄在 55-80 岁、有 30 包年吸烟史的前吸烟者和现吸烟者进行肺癌筛查,这就需要建立高效、有效的系统,大规模提供戒烟服务。这些年龄较大、风险较高的吸烟者与过去烟草依赖行为和药物干预临床试验的参与者不同。在肺癌筛查背景下,如何设计系统以扩大覆盖面并最大限度地提高戒烟率,这方面的知识还存在差距。有八项临床试验,其中七项由美国国家癌症研究所资助,一项由退伍军人健康管理局资助,旨在填补这一空白,并形成 SCALE(肺癌筛查中的戒烟)合作。本文描述了与这些临床试验设计相关的方法学问题:临床工作流程、参与者资格标准、筛查指征(基线或年度重复筛查)、评估内容、戒烟意愿以及治疗提供方法和剂量,所有这些都会影响烟草治疗结果。烟草干预措施考虑了肺癌筛查带来的“可教时刻”,如何纳入阳性和阴性筛查结果,以及如何将戒烟治疗与与肺癌筛查相关的临床事件协调起来。人们对独特的数据元素,如对肺癌风险的认知和烟草治疗成本,很感兴趣。肺癌筛查为降低肺癌导致的发病率和死亡率提供了一个新的、有希望的机会,而有效的戒烟治疗可以放大这一机会。SCALE 的团队合作有望最大限度地提高从临床试验中获得的知识。