In results presented at the International Association for the Study of Lung Cancer (IASLC) 17th Annual World Conference on Lung Cancer in Austria, researchers described “modest success” in a systematic multi-step clinical program to improve tobacco practices that included assessing tobacco use, prescribing pharmacotherapy, and referring patients to smoking cessation counselors.1

Smoking cessation is well known to be critical for both individual and population health, and this is especially true within the context of lung cancer screening.

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Researchers at the University Health System, affiliated with the University of Michigan in Ann Arbor, instituted a formal lung cancer screening program in 2013. To prepare for the program, they randomly audited clinic visits to assess adherence and published guidelines for smoking cessation.

The multi-step program they designed included 4 interventions:

  1. inviting clinic directors to send a clinic staff member for formal training in a Tobacco Treatment Specialist (TTS) course
  2. generating monthly reports showing tobacco use history and pack-years, quit dates for former smokers, use of pharmacotherapy for current smokers, and referrals for either tobacco cessation or formal lung cancer screening
  3. providing monthly feedback to clinic directors comparing their performance to others in the project
  4. initiation of electronic best practice alerts for smokers

Twenty clinical sites affiliated with the University Health System were invited to participate in the program. Staff members at 14 sites completed the TTS course. More than 99% of clinical sites provided initial assessment of tobacco use, but pack-years were recorded less than 40% of the time and quit dates at less than 30%. This was mitigated following staff attendance of the TTS course.

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No increase in the rate of tobacco pharmacotherapy prescription was observed, although there was a gradual increase in the number of referrals for lung cancer screening from an average 30 per month to an average of over 70.


  1. Hamby MK, Nix A, Rysso K, Arenberg D. Preliminary results of a low cost intervention to improve tobacco cessation practices within a large University Health System. Paper presented at: International Association for the Study of Lung Cancer 17th World Conference on Lung Cancer; December 2016; Vienna, Austria.