Nicotine replacement therapy starter packs and gain-framed messages to promote smoking cessation in lung cancer screening: a randomized trial

To the Editor: Combing smoking cessation with lung cancer screening (LCS) confers a 38% mortality benefit compared to 20% with LCS alone.1 Likewise, individuals who quit smoking within 6 months of lung cancer diagnosis have enhanced survival by approximately 30%, which exceeds that achieved by most lung cancer chemotherapies or immunotherapies.2,3 Yet, smoking cessation implementation within LCS and oncology settings is challenging (eg, limited resources, staff, time, training). Comprehensive, embedded cessation programs are ideal and effective4 but are not practical in all locations necessitating effective low to medium touch options. We evaluated the efficacy of a single-session, low touch intervention combing starter packs of nicotine replacement therapy (NRT)5 and gain-framed (GF) messages emphasizing the benefits of smoking cessation6 using a randomized, 2-site (Medical University of South Carolina [MUSC] and Yale) trial design in adults undergoing LCS who reported smoking (n = 308). Participants enrolled July 2017 to April 2023. Research staff contacted patients at or shortly following their LCS visit either in person or virtually. Consented participants completed an intake and were immediately randomly assigned, stratified by site and baseline cessation motivation (high vs low; motivation to quit not required but average motivation was moderate to high across the sample), to either (1) GF smoking cessation patient video and handouts emphasizing the benefits of quitting smoking plus 2-week starter packs of NRT patches (21 mg) and lozenges (4 mg) (GF + NRT) or (2) handouts providing smoking cessation advice but unframed (UF) regarding the outcomes from quitting. They received interventions, including the video if relevant, either same day in clinic or up to 60 days after the scheduled scan. Some of the results of this study have been previously reported in the form of an abstract.7