Smoking cessation interventions for potential use in the lung cancer screening setting: A systematic review and meta-analysis

Abstract

Objectives: Current guidelines recommend delivery of smoking cessation interventions with lung cancer screening (LCS). Unfortunately, there are limited data to guide clinicians and policy-makers in choosing cessation interventions in this setting. Several trials are underway to fill this evidence gap, but results are not expected for several years.

Methods and materials: We conducted a systematic review and meta-analysis of current literature on the efficacy of smoking cessation interventions among populations eligible for LCS. We searched PubMed, Medline, and PsycINFO for randomized controlled trials of smoking cessation interventions published from 2010-2017. Trials were eligible for inclusion if they sampled individuals likely to be eligible for LCS based on age and smoking history, had sample sizes >100, follow-up of 6- or 12-months, and were based in North America, Western Europe, Australia, or New Zealand.

Results: Three investigators independently screened 3,813 abstracts and identified 332 for full-text review. Of these, 85 trials were included and grouped into categories based on the primary intervention: electronic/web-based, in-person counseling, pharmacotherapy, and telephone counseling. At 6-month follow-up, electronic/web-based (odds ratio [OR] 1.14, 95% CI 1.03-1.25), in-person counseling (OR 1.46, 95% CI 1.25-1.70), and pharmacotherapy (OR 1.53, 95% CI 1.33-1.77) interventions significantly increased the odds of abstinence. Telephone counseling increased the odds but did not reach statistical significance (OR 1.21, 95% CI 0.98-1.50). At 12-months, in-person counseling (OR 1.28 95% CI 1.10-1.50) and pharmacotherapy (OR 1.46, 95% CI 1.17-1.84) remained efficacious, although the decrement in efficacy was of similar magnitude across all intervention categories.

Conclusions: Several categories of cessation interventions are promising for implementation in the LCS setting.

Keywords: Lung cancer screening; Meta-analysis; Smoking cessation.

Appendix B.2:. Odds of Smoking Cessation From Random-Effects Meta-Analysis of Trials with Smokers Potentially Eligible for Lung Screening Based on 7-day Point Prevalence of Abstinence at 12-Months by Primary Intervention Type (n= 40 Trials)*

Forest plots display weighted odds ratios and 95% confidence intervals of included trials. Trial weights are generated from a random effects analysis. Squares around point estimates indicate study weight relative to the lowest weighted study for each meta-analysis. The vertical dashed line represents the pooled odds ratio with the diamond representing the 95% confidence interval. * Some trials included more than one intervention of a differing generic type so that the sum of the sample of all intervention types is greater than the total number of trials included.

Appendix B.3:. Sensitivity Analyses Examining Change in Odds of Smoking Cessation From Random-Effects Meta-Analysis of Trials with Smokers Potentially Eligible for Lung Screening Based on 7-day Point Prevalence of Abstinence at 6-Months by Primary Intervention Type (n= 74 Trials)*

Forest plots display weighted odds ratios and 95% confidence intervals of included trials. Trial weights are generated from a random effects analysis. Squares around point estimates indicate study weight relative to the lowest weighted study for each meta-analysis. The vertical dashed line represents the pooled odds ratio with the diamond representing the 95% confidence interval. * Some trials included more than one intervention of a differing generic type so that the sum of the sample of all intervention types is greater than the total number of trials included.

Appendix B.3:. Sensitivity Analyses Examining Change in Odds of Smoking Cessation From Random-Effects Meta-Analysis of Trials with Smokers Potentially Eligible for Lung Screening Based on 7-day Point Prevalence of Abstinence at 6-Months by Primary Intervention Type (n= 74 Trials)*

Forest plots display weighted odds ratios and 95% confidence intervals of included trials. Trial weights are generated from a random effects analysis. Squares around point estimates indicate study weight relative to the lowest weighted study for each meta-analysis. The vertical dashed line represents the pooled odds ratio with the diamond representing the 95% confidence interval. * Some trials included more than one intervention of a differing generic type so that the sum of the sample of all intervention types is greater than the total number of trials included.

Appendix B.3:. Sensitivity Analyses Examining Change in Odds of Smoking Cessation From Random-Effects Meta-Analysis of Trials with Smokers Potentially Eligible for Lung Screening Based on 7-day Point Prevalence of Abstinence at 6-Months by Primary Intervention Type (n= 74 Trials)*

Forest plots display weighted odds ratios and 95% confidence intervals of included trials. Trial weights are generated from a random effects analysis. Squares around point estimates indicate study weight relative to the lowest weighted study for each meta-analysis. The vertical dashed line represents the pooled odds ratio with the diamond representing the 95% confidence interval. * Some trials included more than one intervention of a differing generic type so that the sum of the sample of all intervention types is greater than the total number of trials included.

Appendix B.5:. Contour-Enhanced Funnel Plots to Assess Publication Bias of Smoking Cessation Interventions from a Random Effects Meta-Analysis by Intervention Type

Funnel plots compare the effect estimate of a study to some measure of its precision. Larger more powerful studies are placed at the top and smaller less powerful studies are at the bottom. Contour-enhanced funnel plots add areas of statistical significance to aid in the identification of areas of significance or non-significance from which studies appear to be missing.

Figure 1:. Selection of Trials Published from 2010 to 2018 to Estimate the Efficacy of Smoking Cessation in Lung Screening-eligible Populations

The PRISMA diagram depicts the flow of studies through the phases of the systematic review from study identification to data analysis. A priori reasons for exclusion are presented at each stage.

Figure 2:. Odds of Smoking Cessation From Random-Effects Meta-Analysis of Trials with Smokers Potentially Eligible for Lung Screening Based on 7-day Point Prevalence of Abstinence at 6-Months by Primary Intervention Type (n= 74 Trials)*

Forest plots display weighted odds ratios and 95% confidence intervals of included trials. Trial weights are generated from a random effects analysis. Squares around point estimates indicate study weight relative to the lowest weighted study for each meta-analysis. The vertical dashed line represents the pooled odds ratio with the diamond representing the 95% confidence interval. * Some trials included more than one intervention of a differing generic type so that the sum of the sample of all intervention types is greater than the total number of trials included.