• Division of Pulmonary and Critical Care, CU Cancer Center, University of Colorado, Denver, CO. Electronic address: nina.thomas@cuanschutz.edu.
• Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
• Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.
• Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.
• Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.
• Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
• Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.

BACKGROUND: Lung cancer remains the leading cause of cancer-related mortality in the United States. The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality from lung cancer screening (LCS) with an additive reduction from smoking abstinence. However, successful smoking cessation within lung cancer screening is variable.

RESEARCH QUESTION: What patient and treatment factors are associated with attempts to quit smoking among lung cancer screened patients?

STUDY DESIGN AND METHODS: Secondary analysis of the American College of Radiology Imaging Network (ACRIN) arm of the NLST. Patient demographics, smoking behaviors, tobacco treatment variables were stratified by patient smoking status. Cox proportional hazards ratio was used to evaluate each variable's effect on attempting to quit smoking.

RESULTS: 7,369 patients were actively smoking at enrollment in the NLST. 73.4% of patients who reported they were smoking did not receive any pharmacologic tobacco treatment. More patients who attempted to quit received pharmacologic tobacco treatment than those who continued to smoke: [18.0% vs. 12.4%, p <0.01 nicotine replacement therapy (NRT); 7.9% vs. 6.9%, p=0.02 bupropion; 5.6% vs. 3.9%, p <0.01 both NRT and bupropion]. Stable users were more likely to be women (47.8% vs. 43.8%, p<0.01), African American (8.2% vs 6.3%, p=0.007), unmarried (43.2% vs. 36.9%, p< 0.01) and have less than a college education (47.7% vs. 42.3%, p <0.01). Patients with high dependence who received dual therapy with Bupropion and nicotine replacement therapy (NRT) had the highest likelihood of quit attempt [HR: 2.07(95% CI: 1.75, 2.44).

INTERPRETATION: In this analysis, only a quarter of LCS patients who smoked were treated with pharmacologic therapy, which is associated with increased likelihood of attempting to quit. Certain characteristics are associated with difficulty with attempting to quit smoking. Those with high nicotine dependence benefitted most from dual pharmacologic therapy.