The American Cancer Society National Lung Cancer Roundtable strategic plan: Tobacco treatment in the context of lung cancer screening

Abstract

Tobacco use is the primary contributor to disease and death in the United States, and cigarette smoking is the leading risk factor for lung cancer. Safe and effective treatments for tobacco dependence exist; however, access to and use of tobacco treatment remains low. The most recent Centers for Medicare and Medicaid Services National Coverage Determination requires a shared decision-making visit for lung cancer screening that includes counseling on the importance of maintaining cigarette smoking abstinence if a person formerly smoked; or the importance of smoking cessation if a person currently smokes and, if appropriate, furnishing of information about tobacco-cessation interventions. The directive is not well defined and provides little guidance for delivering high-quality cessation services. Effective integration of best practices for tobacco treatment in the context of lung cancer screening must extend far beyond recommendations to quit, patient literature to reinforce quitting, and available evidence-based treatments. To optimize the provision of tobacco treatment and improve health outcomes in people being screened for lung cancer, the American Cancer Society National Lung Cancer Roundtable Tobacco Treatment in the Context of Lung Cancer Screening Task Group recommends: (1) specify quality indicators and document tobacco treatment delivery; (2) embed tobacco treatment in lung cancer screening; (3) advocate for increased access to tobacco treatment; (4) build and train lung cancer screening staff; (5) provide full coverage of treatment medications; (6) leverage electronic health records to improve the provision of cessation services to lung cancer screenees; and (7) identify and address contextual barriers to incorporating tobacco treatment guidelines in screening.