In a new study of patients with cancer and who smoke, those using e-cigarettes (in addition to traditional cigarettes) were more nicotine dependent and equally or less likely to have quit smoking traditional cigarettes than nonusers. The findings raise doubts about the potential benefits of e-cigarettes for helping patients with cancer give up smoking.

Because of the risks of persistent smoking, all cancer patients who smoke should be advised to quit. But the rising use of e-cigarettes has raised many questions among patients and their health care providers, including whether e-cigarette use helps or hinders quitting efforts. Even regulators are struggling with the complexities associated with e-cigarettes as they weigh the benefits and risks to the general population and subgroups of people.

To examine available clinical data about e-cigarette use and cessation among cancer patients, Jamie Ostroff, PhD, of the Memorial Sloan Kettering Cancer Center in New York, New York, and her colleagues studied 1,074 cancer patients who smoked and were enrolled between 2012 and 2013 in a tobacco-treatment program within a comprehensive cancer center. The results of the study were published in Cancer (2014; doi:10.1002/cncr.28811).

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The researchers observed a three-fold increase in e-cigarette use from 2012 to 2013 (10.6% vs 38.5%). At enrollment, e-cigarette users were more nicotine-dependent than nonusers, had more prior quit attempts, and were more likely to be diagnosed with lung or head and neck cancers. At follow-up, e-cigarette users were just as likely as nonusers to be smoking. Seven-day abstinence rates were 44.4% vs 43.1% for e-cigarette users and nonusers, respectively (excluding patients who were lost to follow-up).

“Consistent with recent observations of increased e-cigarette use in the general population, our findings illustrate that e-cigarette use among tobacco-dependent patients with cancer has increased within the past 2 years,” said Ostroff. She stressed that the study had several limitations, and additional studies are required.

“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, oncologists should advise all smokers to quit smoking traditional combustible cigarettes, encourage use of 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.”