High–Nicotine-Dependent Smokers Less Likely to Quit After Lung Cancer Screening

Key Points

  • Those who had their first cigarette within 5 minutes of waking were significantly less likely to be successful in smoking cessation, significantly more likely to have lung cancer, and had significantly higher rates of death.
  • Assessing nicotine dependence with time to first cigarette can help classify patients undergoing lung cancer screening with regard to their lung cancer risk.

A new study by Rojewski et al in CHEST investigated the relationships between the degree of nicotine dependence and both the likelihood of successfully quitting smoking and clinical outcomes in a cohort of screened patients. The study found that patients with a higher nicotine dependence are less likely to quit post lung cancer screening.

Tobacco cessation is considered the single most effective primary prevention strategy for reducing the risk of lung cancer death in patients. Having a better understanding of smokers and their characteristics can help to better identify their downstream outcomes, determine predictors of continued smoking, and develop a personalized treatment plan. 

Study Methods

Researchers from the Medical University of South Carolina conducted a secondary research analysis of the National Lung Screening Trial (NLST), which included 53,452 current and former (ie, quit within 15 years) smokers between the ages of 55 and 74 years with a minimum 30 pack-year cigarette smoking history. Participants were randomized into three rounds of annual screening with either low-dose computed tomography or chest radiography to screen for lung cancer.

The study first analyzed a subset of 14,125 participants who filled out a more detailed smoking history questionnaire than the other participants. Researchers also aimed to focus on how current nicotine dependence related to medical outcomes in a subset of 7,056 current smokers. To evaluate tobacco dependence, researchers utilized the Fagerström Test for Nicotine Dependence (FTND).

“The FTND is a six-item self-report scale commonly used for the measurement of severity of dependence on cigarettes. It has been recently shown that assessing nicotine dependence with time to first cigarette can help to classify lung cancer screening patients with regard to their lung cancer risk, which may be helpful in shared decision-making visits and establishing better risk-predictive eligibility criteria for screening,” lead author Alana Rojewski, PhD, explained. 

Key Findings

In this study, the researchers found that current smokers have varying levels of tobacco dependence, which can help predict a person’s ability to quit and clinical outcomes. A single question within this screening tool—time to first cigarette—was associated with outcomes in this population. Specifically, those who had their first cigarette within 5 minutes of waking were significantly less likely to be successful in smoking cessation, significantly more likely to have lung cancer, and had significantly higher rates of death.

“Given the extensive smoking histories of lung-screening patients and their risk for poor clinical outcomes, utilizing this information can help to develop tailored tobacco treatment plans,” Dr. Rojewski added. “We have an opportunity to improve risk assessment for lung cancer, which may lead to better individual and health system outcomes in the future.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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