Author: Anna Azvolinsky, PhD
Among cancer patients who smoke, electronic cigarette (e-cigarette) users had greater nicotine dependence compared with traditional cigarette smokers, and e-cigarettes did not help patients quit smoking, according to the results of a study published in Cancer.
According to the study authors, these are the first published results on e-cigarette use and smoking cessation among cancer patients and put into question the potential benefits of using e-cigarettes as part of a smoking cessation program for cancer patients.
Those diagnosed with cancer who continue to smoke are advised to quit. The uptick in the use of e-cigarettes has raised the question of whether these newer types of cigarettes can facilitate or hamper the ability to quit smoking for good.
In the new study, Jamie Ostroff, PhD, of the Memorial Sloan Kettering Cancer Center in New York, examined 1,074 cancer patients who smoked and were enrolled in a tobacco treatment program between 2012 and 2013 at the cancer center.
Using a complete case analysis, e-cigarette users were equally likely to still smoke as those who did not use e-cigarettes (odds ratio of 1). Using an intention-to-treat analysis, e-cigarette users were twice as likely to be smoking at the time of follow-up (odds ratio = 2, P < .01).
The 7-day abstinence from smoking was 44.4% for e-cigarette users compared with 43.1% for non-users.
Patients who were e-cigarette users at study enrollment were likely to be more nicotine-dependent and had more prior attempts at quitting smoking compared to traditional cigarette smokers. E-cigarette users were also more likely to be diagnosed with lung cancer or cancers of the head and neck.
The researchers observed a threefold increase in e-cigarette use, from 10.6% to 38.5% from 2012 and 2013. “Consistent with recent observations of increased e-cigarette use in the general population, our findings illustrate that e-cigarette use among tobacco-dependent cancer patients has increased within the past 2 years,” said Ostroff in a statement.
Follow-up data on cessation was available from 59.5% of the patients on study. Moreover, a significantly higher percentage of e-cigarette users quit the tobacco treatment program or were lost to follow-up compared to those who did not use e-cigarettes (66.3% vs 32.4%, P < .01).
Fifty-seven percent of the patients on study were female, mean age was 56 years, and 69.2% of the patients had tried to quit smoking at least twice prior to enrolling in this study. About one-third of the patients reported a high dependence on nicotine. The highest percentage of patients had thoracic cancer (19.8%), 14.9% had breast cancer, 9.7% had head and neck cancer, and 8% had genitourinary cancer.
First introduced in the United States in 2007, e-cigarettes are battery powered cigarette-like devices that mimic the same sensory experience as traditional cigarettes and provide nicotine for the user.
Still, further studies of broader geographic cohorts and controlled study conditions, are needed. The current study relied on patient responses to assess cessation and was only conducted at a single cancer center.
Controlled research is needed to evaluate the potential harms and benefits of e-cigarettes as a potential cessation approach for cancer patients. In the meantime, said Ostroff, oncologists should advise all smokers to quit smoking traditional combustible cigarettes, encourage patients to use US Food and Drug Administration (FDA)-approved cessation medications, refer patients for smoking cessation counseling, and provide education about the potential risks and lack of known benefits of long-term e-cigarette use.