Smoking Cessation at Lung Examination: The SCALE Collaboration

Stephanie Land
The question is not whether. The question is how to provide cessation services in the setting of lung cancer screening.”
Stephanie Land, Ph.D., Behavioral Research Program

What is the SCALE Collaboration?

The Smoking Cessation at Lung Examination (SCALE) Collaboration is an initiative sponsored by the National Cancer Institute (NCI) to conduct research on lung cancer screening and smoking cessation treatment with a specific group: long-term smokers who are screened for lung cancer using low-dose computed tomography (LDCT).

The pairing of smoking cessation treatment and LDCT screening has the potential to generate a large pool of data on screening and cessation outcomes. This pool will be valuable to researchers studying issues such as the possible connection between smoking cessation rates and expansion of LDCT facilities or how to provide these services most effectively in a variety of clinical settings.

The purpose of the SCALE Collaboration is to share data and methods from eight funded research projects to enable cross-project research on smoking cessation interventions in the setting of LDCT lung cancer screening.

Members of the SCALE Collaboration selected measures they considered important to share for research in this setting. This set of measures, called the “SCALE Measures Special Collection exit disclaimer,” includes:

  • Demographics, personal experiences, and family medical history
  • Psychological variables
  • Historical and current smoking behavior, smoking cessation attitudes/experiences, and smoking cessation outcomes measures
  • Implementation and organizational measures
  • Medical outcomes

SCALE members also share best approaches to measuring feasibility, cost, and other implementation outcomes and to disseminating results and resources.

What findings led to the development of the SCALE Collaboration?

In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended annual LDCT screening for individuals who:

  • Are current smokers or former smokers who have quit within the last 15 years
  • Have smoked for at least 30 pack-years (e.g., an average of one pack a day for 30 years, or two packs a day for 15 years)
  • Are between the ages of 55 and 80 and have no symptoms

LDCT screening for high-risk individuals is covered by Medicare and by private insurance under the Affordable Care Act. In 2021, the USPSTF updated its recommendations, expanding the pack-year requirement from 30+ to 20+ and the age range from 55-80 to 50-80.

According to studies examining lung cancer screening rates among current and former smokers, about 50% of screening participants are current smokers. Therefore, LDCT screening represents an important opportunity to offer high-risk smokers help in quitting.

Offering smoking cessation treatment fits with U.S. Public Health Service’s tobacco treatment guidelines (Clinical Practice Guideline: Treating Tobacco Use and Dependence, 2008 Update) that call on clinicians and health care delivery systems not only to ask patients about tobacco use and document it, but also to “treat every tobacco user seen in a health care setting.”

Delivering smoking cessation treatment with LDCT screening has great potential to reduce tobacco use and smoking-related illness and death in the large population of smokers, and it appears to be a highly cost-effective way to do so.

Despite evidence for effectiveness, public health recommendations, and the support of professional organizations and insurers, screening programs have not always been accompanied by smoking cessation treatment.

How was the SCALE Collaboration developed?

Five of SCALE’s projects are funded by NCI grants awarded in September 2016 to support cross-project research on the design and implementation of smoking cessation interventions in lung cancer screening settings through a request for applications titled “Smoking Cessation within the Context of Lung Cancer Screening (RFA-CA-15-011).” The anticipated NCI budget is a total of $18.4 million over five years. Three additional projects relating to LDCT screening and smoking cessation (two funded by NCI and one funded by the U.S. Department of Veterans Affairs) also joined the collaboration.

Contributors to the development of the SCALE Measures Special Collection were David Abrams (Truth Initiative), David Chambers (NCI), Caroline Chiles (Wake Forest University), Paul Cinciripini (University of Texas MD Anderson Cancer Center), Kristie Foley (Wake Forest University), Jaimee Heffner (Fred Hutchinson Cancer Research Center), Anne Joseph (University of Minnesota), Annette Kaufman (NCI), Stephanie Land (NCI), Rafael Meza (University of Michigan), Jamie Ostroff (Memorial Sloan Kettering Cancer Center), Alex Rothman (University of Minnesota), Elizabeth Seaman (Westat), Donna Shelley (New York University), Kathryn Taylor (Georgetown University), Benjamin Toll (MUSC), Gordon Willis (NCI), and Steven Zeliadt (University of Washington).

SCALE Investigators, Research Centers, and Funded Projects

All projects funded by the National Cancer Institute unless otherwise noted

Where can I find more information regarding the SCALE Collaboration?

  • Cadham CJ, Cao P, Jayasekera J, Taylor KL, Levy DT, Jeon J, Elkin E, Foley KL, Joseph A, Kong CY, Minnix JA, Rigotti NA, Toll BA, Zeliadt SB, Meza R, Mandelblatt J; CISNET-SCALE Collaboration. Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study. J Natl Cancer Inst. 2021 Jan 23:djab002. doi: 10.1093/jnci/djab002. Epub ahead of print. PMID: 33484569.
  • Foley K, Chiles C, D’Agostino R, Miller D, Weaver K, Sutfin E, Ostroff J, Shelley D, King J, Ciupek A, Criswell A, Fallon S, Taylor K. Organizational Priority, Feasibility, and Acceptability of Offering Evidence-Based Smoking Cessation Support During Routine Lung Screening. Poster (POS3-63; p. 199) presented at the 2019 Society for Nicotine and Tobacco Research Annual Convention. February 2019, San Francisco, CA.
  • Joseph A, Cinciripini P, Foley K, Kim E, Schertz K, Toll B, Taylor K. Baseline Characteristics of Smokers Who Enroll and Decline SCALE Trial Participation. Poster (POS3-64; p. 200) presented at the 2019 Society for Nicotine and Tobacco Research Annual Convention. February 2019, San Francisco, CA.
  • Heffner J, Krebs P, Wheat C, Johnson H, Feemster L, Klein D, Au D, Zeliadt S. Tobacco Treatment Utilization Among Veterans Receiving Lung Cancer Screening Through the Veterans Health Administration. Poster (POS3-65; p. 200) presented at the 2019 Society for Nicotine and Tobacco Research Annual Convention. February 2019, San Francisco, CA.
  • Meza R, Cao P, Jayasekera J, Levy D, Cadham C, Advani S, Braithwaite D, Mandelblatt J, Jeon J. Potential Impact of Joint Screening and Cessation Program on Smoking, Lung Cancer and Overall Mortality. Poster (POS3-66; p. 200) presented at the 2019 Society for Nicotine and Tobacco Research Annual Convention. February 2019, San Francisco, CA.
  • Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM. Lung cancer screening and smoking cessation clinical trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) collaboration. American Journal of Respiratory and Critical Care Medicine. 2018; 197(2): 172-182.
  • NCI Board of Scientific Advisors Meeting presentation, Smoking Cessation within the Context of Lung Cancer Screening RFA Concept (beginning at 4:49:50). March 2015.

Selected Smoking Cessation Resources

Last Updated
September 24, 2020