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Gene-based risk test for lung cancer risk motivates smoking cessation in randomly selected smokers.Raewyn J Hopkins BN, MPH1, Robert P Young, MD, PhD1,2, Bryan Hay, BSc1, Greg D Gamble, MSc1. 1Department of Medicine and Biological Sciences, University of Auckland, Synergenz Biosciences Ltd, PO Box 37-971, Auckland, NZ

Dr Robert Young

BMedSc, MBChB, DPhil, FRACP, FRCP

Associate Professor of Medicine and Molecular Genetics

Department of Medicine, University of Auckland, Auckland, New Zealand

which do you respond to
Which do you respond to?

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which do you respond to1
Which do you respond to?
  • “Public Health Approach”
  • Non-personalised
  • Health warning
  • Recommendation
  • “What people read and ignore”

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  • “Personalised Approach”
  • Smoker specific risk
  • Personal engagement
  • Outcome specific
  • “What people are told
  • and what will happen
  • if they don’t act”

?

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Danger and fear changes risky behaviour

3

which do you respond to2
Which do you respond to?
  • “Public Health Approach”
  • Non-personalised
  • Health warning
  • Recommendation
  • “What people read and ignore”

Speed

Limit

  • “Personalised Approach”
  • Smoker specific risk
  • Personal engagement
  • Outcome specific
  • “What people are told
  • and what will happen
  • if they don’t listen”

Speed

Camera

4

Lung cancer risk test

respiragene tm test motivational tension and quitting
RespirageneTM test - motivational tension and quitting
  • Personalised tests of risk - change behaviour by increasing motivational tension (fear)
  • Respiragene is a gene based personalised test of lung cancer susceptibility
  • Respiragene is a test to engage smokers in the risks of smoking and a trigger to quitting
  • Respiragene does not de-motivate smokers and reminds them all that they are at risk of lung cancer

5

slide6
Smoking cessation: triggers
  • Most smokers quit using cold turkey
  • For older smokers, future poor health is the most cited reason for quitting
  • Developing lung cancer and COPD are the most feared complications
  • Most smokers continue to smoke on the basis the benefits outweigh the harms
  • Most smokers overestimate the general risk of lung cancer but underestimate their own risk (below average risk = optimistic bias)
  • Smokers quit when the motivational tension favour quitting (trigger)
  • Young RP, et al. 2009 (PMJ)

Nothing Treatment Events

slide7
The main thrust of this paper is that smokers are looking for better

reasons to quit than just non-personalised public health messages

Smokers are motivated to quit by triggers that raise motivational tension

and that these triggers include tests indicating future ill health.

genetic risk of lung cancer and quitting
Genetic risk of lung cancer and quitting

Genetic testing for risk of lung cancer helps to personalize the risk from continued smoking

Smokers who underwent genetic testing (blue bars) in a randomized trial had higher quit rates than those in a smoking cessation programme alone (yellow bars)

Personalising the risks of smoking helps people choose healthier lifestyle options (eg quitting smoking and preventing relapse)

McBride,C.M., et al: Incorporating genetic susceptibility feedback into a smoking cessation

program for African-American smokers with low income. Cancer Epidemiol Biomarkers Prev.2002, 11:521-528

8

slide9
Smoking cessation
  • Most smokers quit using cold turkey
  • For older smokers, future poor health is the most cited reason for quitting
  • Developing lung cancer and COPD are the most feared complications
  • Most smokers continue to smoke on the basis the benefits outweigh the harms
  • Most smokers overestimate the general risk of lung cancer but underestimate their own risk (below average risk = optimistic bias)
  • Smokers quit when the motivational tension favour quitting (trigger)

Genetic testing for lung cancer risk

Nothing Treatment Events

3ts robert west how fear triggers quitting
3Ts – Robert West- How fear triggers quitting

BMJ 2006; 332:458-460

Tension = motivational tension is the level of fear and anxiety

a smoker experiences that arises from the combined feeling from beliefs, past experiences and the balance of benefit over harms from continued smoking.

Trigger = “events” that alter the motivational tension to a point a smoker acts on their fears and initiates a quit attempt.

Treatment = the provision of smoking cessation services such as pharmacotherapy, counselling or referral to a specialised smoking cessation service

10

smoking cessation tension
Smoking cessation: Tension

Tension

Trigger

Treatment

Smoker = Benefits outweigh the harms

  • Motivational tension low
  • fear/anxiety about smoking
  • promotes quitting
  • Optimistic bias high
  • denial about smoking risks
  • promotes smoking

Smoker

West R et al. BMJ 2006; 332: 458-60

11

smoking cessation the 3 ts
Smoking cessation: the 3 Ts

Tension

Trigger

Treatment

Quitter = Harms outweigh the benefits

Tip the balance

to achieve quitting

  • Optimistic bias low
  • denial about smoking risks
  • promotes smoking
  • Motivational tension high
  • fear/anxiety about smoking
  • promotes quitting

Personalised test of vulnerability

ie. Respiragene Test

Ex-smoker

Trigger = “Teachable moment”

“Fear is a powerful motivator” but it must be personalised

12

slide14
Tool of engagement
  • Smoker’s feedback
  • Smokers wanted information that caught their attention
  • Current public health campaigns are not engaging
  • Smokers don’t read packet warnings
  • TV adds reminded smokers to light up
  • Smokers want information personally relevant (and honest) not “a lecture”

Risk Level

200x

20x

Score

No smoker is lower than “moderate” (elevated) risk for lung cancer vs non smokers

slide15
Test to engage, educate and empower smokers
  • Lung cancer susceptibility score
  • All smokers at some risk for lung cancer above that of non-smokers
  • Factors increasing that risk
    • Increasing age
    • Family history
    • COPD (smoker’s lung)
    • “Bad genes”
  • Shows risk reduction with quitting
  • Educational tool to promote behaviour change (quitting)

Risk Level

200x

20x

Score

No smoker is lower than “moderate” (elevated) risk for lung cancer vs nonsmokers

respiragene test and smoking cessation feasibility study in smokers not seeking quit support
Respiragene test and smoking cessation – feasibility study in smokers not seeking quit support
  • Identified and randomly recruited current smokers over 40 yo.
  • Telephone survey to assess smoking habits and attitudes to quitting
  • Offered genetic test (optional), arranged testing (V1) and then gave results + info (V2)
  • Telephone survey to assess smoking habits and attitudes to quitting at 6 months after testing.
changes in smoking before and after genetic testing
Changes in smoking before and after genetic testing

6 months before testing

(n=38 smokers)

6 months after testing

(n=38 smokers)

1

1

5

11

10

12

11

3

4

5

3

Quit

Abstained 3+ days

Abstained 1-2 days

Abstained up to 1 day

Have cut down cigs/day

No change in smoking

Quit

Abstained 3+ days

Abstained 1-2 days

Abstained up to 1 day

Have cut down cigs/day

No change in smoking

4

6

2

4

5

2

2

3

2

P<0.05

N=38

N=38

After genetic testing changes in smoking;

32 (84%) greater abstinence (blue) vs 3 (8%) less abstinence (red)

(3 unchanged (orange)

changes in smoking before and after genetic testing1
Changes in smoking before and after genetic testing

6 months before testing

(n=38 smokers)

6 months after testing

(n=38 smokers)

32% Quit rate

at 6months

1

1

5

11

10

12

11

3

4

5

3

Quit

Abstained 3+ days

Abstained 1-2 days

Abstained up to 1 day

Have cut down cigs/day

No change in smoking

Quit

Abstained 3+ days

Abstained 1-2 days

Abstained up to 1 day

Have cut down cigs/day

No change in smoking

4

6

2

4

5

2

2

3

2

P<0.05

N=38

N=38

After genetic testing changes in smoking;

32 (84%) greater abstinence (blue) vs 3 (8%) less abstinence (red)

(3 unchanged (orange)

daily cigarette consumption pre and post genetic testing
Daily cigarette consumption pre- and post genetic testing

6 months after testing

(n=38 smokers)

6 months before testing

(n=38 smokers)

12

6

11

3

5

1

0

0

0

9

2

12

0

2

Quit

5 cigs/day

10 cigs/day

15 cigs/day

20 cigs/day

25 cigs/day

30+ cigs/day

5

82% reduced

cigarette consumption

Quit

5 cigs/day

10 cigs/day

15 cigs/day

20 cigs/day

25 cigs/day

30+ cigs/day

6

3

2

3

2

6

3

*

3

P<0.05

*diagnosed Prostate

cancer after testing)

After genetic testing changes in cigs/day;

12 (32%) Quit smoking, 12 (32%) halved consumption, overall 82% decreased cigs/day (blue),

while 6 (16%) unchanged (orange) and 1 (2%) increased (red) consumption *

respiragene test results in smokers
Respiragene Test results in smokers
  • 84% accepted offer of Respiragene testing
  • 96% stated helpful in motivating quitting
  • 32% quit at 6 months
  • a further 32% had decreased cigarette consumption (82% decrease in smoking overall)
  • 63% had purchased NRT as part of their effort to quit
  • 8% appeared “demotivated” by testing
slide22
D

Ask

Brief advice

Cessation

Do testing

Use tests of risk or organ damage

to engage smokers

and “personalise” advice

Spirometry to assess lung age

(sign of generalised susceptibility

to cardiopulmonary complications)

Take Respiragene Test for lung cancer risk score

Cost: $150 or $75 via GP

smoker taking the respiragene test feedback
Smoker taking the Respiragene Test: feedback

Female, 61 yo, 20 cigs/day for 46 years with no previous quit attempts, June 2010.

She says…

“We are talking about an addiction here, one of the strongest known to mankind and perpetuated for years and years by the Tobacco companies as safe and glamorous.

When I took the Respiragene Test I was a  long term smoker and I was horrified at the results and it made me more determined to quit so I cannot see where people think this is a test to give a ‘green light’ for smoking.  There is no level of cigarette smoking that is good for you.   

The test itself is very easy and quick but the results are really shocking and certainly affected me in a positive way to quit. I have been smoke free for 6 months now and intend never to pick up another cigarette for the rest of my life and in fact have no desire to do so. 

This test should be mandatory to anyone who smokes and is admitted to hospital for any reason or made available to General Practitioners for use with patients who smoke.  It’s a way to see what is happening inside your body and to prevent more damage”.

respiratory genetics group university of auckland new zealand

Respiratory Genetics GroupUniversity of Auckland, New Zealand

Respiratory Genetics Team

University of Auckland, New Zealand

Robert Young DPhil, FRACP

Raewyn Hopkins BN, MPH

Greg Gamble MSc

Bryan Hay BSc

Chris Whittington MSc

Synergenz BioScience Ltd

www.Respiragene.com (US) or

www.Synergenz.com (non-US)

Collaborators

Dr Kyle Hogarth - University of Chicago

Dr John Field – University of Liverpool

Dr Javier Zulueta – University of Navarra

NZ Collaborators

Mike Epton MD FRACP

Peter Black FRACP

Tim Christmas MD FRACP

which do you respond to3
Which do you respond to?
  • “Public Health Approach”
  • Non-personalised
  • Health warning
  • Recommendation
  • “What people read and ignore”

Speed

Limit

  • “Personalised Approach”
  • Smoker specific risk
  • Personal engagement
  • Outcome specific
  • “What people are told
  • and what will happen
  • if they don’t listen”

SMOKING WILL

KILL YOU

Speed

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25

engaging smokers in smoking cessation role of respiragene
Engaging smokers in smoking cessation: role of Respiragene *

Arrange *

Assist

Ask

Advise

Assess*

Relevance *

  • Respiragene testing…….
  • facilitates follow-up visit for a consultation focussed on……
  • - Respiragene result, and
  • - cessation options
  • Reminder of result on subsequent visits
  • Update of risk according to spirometry
  • Respiragene testing…….
  • to engage smokers
  • in smoking cessation
  • assess risk of lung cancer
  • and benefits of quitting
  • increase motivation in
  • favour of quitting

Rewards *

Risks *

Roadblocks

Repetition *

5As and 5Rs

smokers response to respiragene testing
Smokers response to Respiragene testing

Smokers want a reason to quit and help with quitting

  • Over 80% said they would take a test assessing risk of lung cancer if offered.
  • 6 months after testing with the lung cancer test
    • 48% used smoking cessation products
    • 32% quit – same proportion from all 3 risk groups
    • 28% halved their cigarette consumption
    • 100% would recommend to family
    • 96% would recommend to smoking friends
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