Randomised trial of delivering co-located, personalised stop-smoking support within lung cancer screening: the YESS study

INTRODUCTION: Lung cancer screening (LCS) with low-dose CT offers a teachable moment for smoking cessation (SC), but the optimal way to implement SC within LCS is unclear. The Yorkshire Enhanced Stop Smoking (YESS) study assessed the efficacy of a personalised stop-smoking intervention delivered alongside LCS. METHODS: Opt-out, co-located SC support, comprising nicotine replacement therapy/e-cigarettes/pharmacotherapy and behavioural support, was offered to all individuals who currently smoked attending for LCS. Four weeks later, participants were offered recruitment to a randomised controlled trial of continued standard best practice (SBP) versus a personalised SC support package, including a booklet containing CT images of participants' own heart and lungs, annotated where appropriate to highlight emphysema or coronary artery calcification and scripted communication delivered by a smoking cessation practitioner. RESULTS: 1003 people were recruited; 52.5% were allocated to the intervention group. Validated 7-day point prevalent (PP) abstinence rates were 33.6% and 30.0% in the intervention versus SBP groups, respectively (OR 1.17, 95% CI 0.90 to 1.54) at 3 months and 29.2% versus 28.6% (OR 1.03, 95% CI 0.78 to 1.36) at 12 months post-screening. Subgroup analyses indicated a significant increase in 7-day PP abstinence at 3 months with the intervention in women (33.9% intervention, 23.1% SBP, OR 1.70, 95% CI 1.15 to 2.53) but not in men (33.3% intervention, 37.8% SBP, OR 0.82, 95% CI 0.57 to 1.19). CONCLUSION: Around one-third of study participants were abstinent from smoking at 3 months post-screening irrespective of study arm, but adding the personalised intervention did not increase quit rates. Further research is needed exploring possible sex differences in efficacy of personalised SC support. The high overall quit rate reinforces the value of SC support delivered alongside LCS. TRIAL REGISTRATION NUMBER: ISRCRN 63825779 and NCT03750110.