An Optimization Randomized Clinical Trial to Identify an Effective, Efficient Smoking Cessation Intervention in the Context of Lung Cancer Screening: Cessation and Screening to Save Lives (CASTL).

Abstract

Approximately 50% of the estimated 14 million people eligible for lung cancer screening (LCS) currently smoke. Gaps in knowledge regarding optimal tobacco treatment interventions in the context of LCS remain. Research Questions; What are the most value-efficient, evidence-based combination of tobacco treatment component(s) for people seeking LCS who smoke? Study Design and Methods; Cessation and Screening to Save Lives (CASTL) is an optimization randomized clinical trial conducted at 17 LCS sites in the United States. Eligible participants ages 50-80, scheduled for LCS, and currently smoking were randomized to one of 16 combinations of tobacco treatment components: enhanced standard care, motivational interviewing, nicotine patch/ lozenge and message framing. The primary outcome was self-reported abstinence at 6 months follow-up. The cost of each combination of components was estimated as a function of time and resources. Results; At enrollment (N=758), about 5% of participants were not interested in quitting, 59% were considering quitting and 38% already making changes in their smoking. Most (79%) reported smoking within 30 minutes of waking, indicating high level of addiction. Although there were no significant differences among the intervention components, the most value-efficient intervention with respect to expected abstinence was loss-framed messaging, nicotine patch and lozenge (expected abstinence rate = 30%; mean cost = $287.41). Among the less-costly combinations, a value-efficient alternative included gain-framed messaging only (abstinence = 13%; cost = $51.29).