Georgetown University Medical Center, D.C., USA.
Lahey Hospital and Medical Center, Burlington, MA, USA.
Contemp Clin Trials. 2021 Jul;106:106429. doi: 10.1016/j.cct.2021.106429. Epub 2021 May 6.
Although it is a requirement that tobacco treatment is offered to cigarette smokers undergoing low-dose computed tomographic lung cancer screening (LCS), not all smokers engage in treatment. To understand the barriers to tobacco treatment in this setting, we evaluated predictors of attrition in a smoking cessation trial among individuals undergoing LCS.
Prior to LCS, 926 participants, 50-80 years old, completed the baseline (T0) phone assessment, including demographic, clinical, tobacco, and psychological characteristics. Following LCS and receipt of the results, participants completed the pre-randomization (T1) assessment.
At the T1 assessment, 735 (79%) participants were retained and 191 (21%) dropped out. In multivariable analyses, attrition was higher among those who: smoked >1 pack per day (OR = 1.44, CI 1.01, 2.06) or had undergone their first (vs. annual) LCS scan (OR = 1.70, CI 1.20, 2.42). Attrition was lower among those with: more education (associates (OR = 0.67, CI = 0.46, 0.98) or bachelor's degree (OR = 0.56, CI 0.35, 0.91) vs. high school/GED), some (vs. none/a little) worry about lung cancer (OR = 0.60, CI 0.39, 0.92), or a screening result that was benign (OR = 0.57, CI 0.39, 0.82) or probably benign (OR = 0.38, CI 0.16, 0.90) vs. negative.
This study illuminated several LCS-related factors that contributed to trial attrition. Increasing tobacco treatment in this setting will require targeted strategies for those who report little lung cancer worry, are undergoing their first LCS exam, and/or who have a negative LCS result. Addressing attrition and reducing barriers to tobacco treatment will increase the likelihood of cessation, thereby reducing the risk of developing lung cancer.
尽管向接受低剂量计算机断层扫描肺癌筛查 (LCS) 的烟民提供烟草治疗是一项要求，但并非所有吸烟者都接受治疗。为了了解在这种情况下烟草治疗的障碍，我们评估了在接受 LCS 的个体中进行的戒烟试验中脱落的预测因素。
在 LCS 之前，926 名年龄在 50-80 岁的参与者完成了基线 (T0) 电话评估，包括人口统计学、临床、烟草和心理特征。在 LCS 和收到结果后，参与者完成了预随机化 (T1) 评估。
在 T1 评估时，735 名（79%）参与者保留，191 名（21%）脱落。在多变量分析中，以下因素的脱落率更高：每天吸烟>1 包（OR=1.44，CI 1.01，2.06）或首次（而非每年）接受 LCS 扫描（OR=1.70，CI 1.20，2.42）。具有以下特征的参与者脱落率较低：受教育程度较高（副学士（OR=0.67，CI=0.46，0.98）或学士学位（OR=0.56，CI 0.35，0.91）与高中/ GED 相比），对肺癌有一些（而非没有/一点）担忧（OR=0.60，CI 0.39，0.92），或筛查结果为良性（OR=0.57，CI 0.39，0.82）或可能良性（OR=0.38，CI 0.16，0.90）与阴性。
本研究阐明了导致试验脱落的一些与 LCS 相关的因素。在这种情况下增加烟草治疗需要针对那些报告肺癌担忧较少、正在接受第一次 LCS 检查和/或 LCS 结果为阴性的人制定有针对性的策略。解决脱落问题和减少烟草治疗的障碍将增加戒烟的可能性，从而降低患肺癌的风险。
