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Adam Goldstein and Kimberly Shoenbill.
Adam Goldstein, MD, MPH, and Kimberly Shoenbill, MD, PhD, MS.

In an editorial in the Journal of Thoracic Oncology, UNC Lineberger’s Kimberly Shoenbill, MD, PhD, MS, and Adam Goldstein, MD, MPH, outlined the need for health professionals to work collaboratively to optimize tobacco cessation treatment in patients undergoing lung cancer screening. They contend it is critical to reduce smoking-related health issues and deaths.

The U.S. Preventive Services Task Force currently recommends annual screening for lung cancer with low-dose computed tomography in adults aged 50 to 80 years who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years and no health problems that limits life expectancy or the ability to have lung surgery. (A pack-year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 20 pack-year history by smoking one pack a day for 20 years or two packs a day for 10 years.)

Previous studies have shown that smoking cessation and lung cancer screening each provide benefits for patients, and the combination of both is more effective in reducing mortality than either one alone. Yet, Shoenbill and Goldstein point out, nearly half of the patients eligible for lung cancer screening are still addicted to tobacco products.

“Given that lung cancer remains the second most diagnosed cancer, the leading cause of cancer death, and that smoking remains the leading cause of lung cancer, established interventions that increase lung cancer screening and assist those eligible for lung cancer screening to quit smoking are essential in efforts to reduce lung cancer morbidity and mortality,” they wrote.

Shoenbill said patients who are eligible for lung cancer screening often experience a high level of addiction, which is associated with higher levels of health risks and the need for comprehensive cessation treatment, including access to medications designed to decrease nicotine withdrawal symptoms and curb or eliminate the urge to smoke cigarettes.

“These patients have long-term, usually high levels of smoking, making quitting much more difficult,” said Shoenbill, assistant professor in family medicine and director of the UNC Tobacco Treatment and Weight Management Programs at the UNC School of Medicine. “Their need for intensive counseling to address the complex interplay of physical and psychosocial manifestations of addiction and their need for therapeutic cessation medication support in high enough doses are often not adequately addressed in short-term discussions of cessation during busy clinical visits.”

They also outlined four steps to address gaps in the healthcare system that impede lung cancer screening and tobacco use counseling: improve the identification of patients eligible for lung cancer screening; increase patient and provider awareness on expanded screening guidelines, the importance of both early lung cancer screening and intensive tobacco cessation treatment; pair screening with intensive treatment, including a minimum of four counseling sessions and drug therapies; and improve the collection of comprehensive medical histories, including tobacco use and cessation attempts, social determinants of health, and emerging predictive biomarkers in order to facilitate the development of a tobacco use treatment plan that is tailored to each patient.

Goldstein, the Elizabeth and Oscar Goodwin Distinguished Professor and director of Tobacco Intervention Programs at the UNC School of Medicine, said more healthcare systems need to prioritize identifying patients who smoke and are eligible for lung cancer screening and ensuring these patients receive comprehensive treatment and counseling, including providing medications.

“It is time to make new cases of lung cancer – and even deaths from lung cancer – extinct,” Goldstein said.