Electronic Cigarettes for Smoking Cessation in Lung Cancer Patients: A Feasibility Study

Background

Many patients diagnosed with Stage 4 lung cancer continue to smoke even though this can make their treatment less effective and increase side effects. E-cigarettes form part of the UK’s tobacco harm reduction policy landscape and are, by far, smokers’ most popular quit attempt method. This pilot study explored the feasibility and acceptability of e-cigarettes to aid smoking cessation among lung cancer patients undergoing chemotherapy.

Studies have shown that patients smoking at a time of diagnosis with stage 4 disease have a worse prognosis when compared to former smokers (Ferketich et al, 2013) or never smokers. The explanation is likely to be related both to tumour biology but also to poorer response to treatments such as radiotherapy and systemic therapies, such as certain chemotherapy drugs.  

Many patients diagnosed with lung cancer continue to smoke even though this can make their treatment less effective and increase side effects. How can we help them to stop smoking?

What is the problem to be addressed?

As we can see, many lung cancer patients continue to smoke after receiving a diagnosis. Despite the availability of smoking cessation services in Scotland these are largely community-based, and cancer patients face barriers to accessing them during treatment. Electronic cigarettes are consumer products which have promise for smoking cessation and may provide a new option for patients to stop smoking. Might they provide a viable, effective, and acceptable way to help people living with Stage 4 lung cancer to stop smoking cigarettes?

Findings and potential impact

Methods:

27 smokers with Stage 4 lung cancer were recruited from one NHS site in Scotland between May 16th and June 17th 2016. They were provided with a second-generation e-cigarette kit at a baseline home visit conducted by a researcher and a volunteer who was an experienced e-cigarette user. Participants were followed-up weekly for four weeks and at 16 weeks. Participants´ response to, and use of, e-cigarettes was explored along with cessation outcomes. In-depth qualitative interviews were conducted with health professionals engaged with lung cancer patients to obtain their views on the study.

Results:

Overall, participants were motivated to stop smoking and took easily to using e-cigarettes. Minor issues arose around choice of flavour, and some side effects were noted, although participants reported difficulty in distinguishing these from treatment side effects. Seven participants were lost to follow-up. Preliminary findings showed that at four-week follow-up: average carbon monoxide (CO) reading had reduced from 14 (range 3-37) to 8 (range 1-29), and 70% of participants reported daily e-cigarette use. However, use was dependent on individuals’ day-to-day health. Health professionals interviewed were generally supportive of e-cigarettes as a tool for quitting, and suggested future efforts should concentrate on patients with curable cancer.

Professor Bauld stated that: ‘’E-cigarettes have a potential role to play for lung cancer patients. Future smoking cessation research should take account of the impact of cancer treatment on emotional and physical health and explore e-cigarette use among patients with earlier stage lung cancer’’.

In her report following the end of the project, she added:

Conclusions:

Results from existing trials suggest that e-cigarettes may increase the chance of stopping smoking compared to placebo, but further research is needed (Hartman-Boyce et al, 2016). Consensus is also emerging that, as a harm reduction strategy, e-cigarette use may be beneficial and although some concerns remain, potential benefits outweigh harms (RCP, 2016, Hajek et al, 2014, NASEM, 2018). However, further research, particularly in groups with high smoking prevalence who are not able or willing to use more traditional approaches to cessation, will be important if we are to realise the potential of these products (McNeill et al, 2018).

Health professionals have expressed concern about longer term e-cigarette safety but welcomed the study. Smoking cessation should be offered to patients who have incurable disease

Publications and presentations:

Professor Bauld’s paper, ‘Feasibility and acceptability of e-cigarettes as an aid to quitting smoking among lung cancer patients: a pilot study’, was published in the journal TID (Tobacco Induced Diseases) in March 2018, and in JTO (the Journal of Thoracic Oncology) Vol. 13 No. 10S, in October 2018.  

An update was also presented by her colleague, Lesley Sinclair, at our 2018 Alumni Update conference in London.

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Lead researchers:Linda Bauld | Location: | Type of research: Smoking cessation