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UKNSCC London 2016
E-cigarettes for
lung cancer patients
Lesley Sinclair
on behalf of study team
Outline
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Background
Aims of objectives
Methods
Challenges to date
Progress so far
Feasibility & acceptability of electronic cigarettes as an aid
to smoking cessation for lung cancer patients
Funded by: Roy Castle Lung Cancer Foundation
Grant Holders/Project Team
Professor Linda Bauld, University of Stirling
Dr Stephen Harrow Beatson West of Scotland Cancer Centre
Dr Hayden McRobbie, University of Auckland, New Zealand
Ms Lesley Sinclair, University of Stirling
Dr Kirsten Laws, ANCOR Unit, Aberdeen Royal Infirmary
Ms Jennifer McKell, University of Stirling
with assistance from Mr Andy Morrison, New Nicotine Alliance
Collaborators
Professor Anthony Chalmers, University of Glasgow, Professor John Britton, University of Nottingham,
Dr Kevin N Franks, St James Institute of Oncology and University of Leeds
Background
• Tobacco use is leading
preventable cause of cancer 64,500 cases in UK each year
• 37,200 lung cancer cases
• In UK around 30% of lung
cancer patients still smoking at
time of diagnosis (Park et al 2012)
• Recent audit in study site
found 2 out of 3 lung cancer
patients being treated with
curative intent with
radiotherapy or combination
chemo/radio therapy still
smoking during treatment
Smoking and cancer treatment
• Continued smoking can have adverse outcomes for cancer
patients undergoing treatment. The 2014 US Surgeon
General’s Report concluded that:
In cancer patients and survivors, the evidence is suggestive
but not sufficient to infer a causal relationship between
cigarette smoking and the risk of recurrence, poor response
to treatment, and increased treatment-related toxicity
• Other research suggests that patients undergoing
radiotherapy who smoke are at increased risk of
recurrence, a 2nd cancer developing, or death (Warren et al, 2014)
• Smoking cessation relevant for primary and secondary
prevention
Why might smoking affect cancer
treatment?
• Number of mechanisms by which continued
smoking might undermine different cancer
treatments:
– Smoking has effect on cancer cell proliferation
(contributing to the initiation, promotion and
progression of cancer)
– Some of the toxicants in tobacco smoke have also
been shown to slow down cancer cell death
– Tobacco smoke may increase metastasis and may
affect tumour cell immune responses
Why electronic cigarettes?
• E-cigarettes form part of current tobacco harm reduction
policy ‘landscape’ in UK (NICE, 2013, RCP, 2016)
• Controversial but widely used (2.8 million users)
• Hypothesis: may be particularly valuable for groups of
smokers who have tried other approaches to stopping
smoking and failed – could include lung cancer patients
• Results from recently conducted study by members of team
on cancer diagnosis as opportunity for smoking cessation in
Scotland (Wells et al, 2015) found that:
– Although cancer patients who smoked were motivated to quit, many
found this difficult
– Very few knew about, were referred to, or accessed, stop smoking
services
– Stop smoking services also not set up in way that made them
accessible to cancer patients undergoing treatment
• Alternative approaches need testing
Aims and Objectives
Explore if e-cigs viable alternative to aid smoking
cessation for stage IV lung cancer patients
• Assess feasibility and acceptability of providing e-cigs
with advice & support
• Explore views of lung cancer patients, family & friends
& professionals
• Examine how patients respond to & use e-cigs
• Monitor cessation outcomes during treatment period
• Assess perceptions of care, support & e-cig use
Inform future trial on benefits to survival & QoL
Methods
Study Design: 12 month pilot study with nested qualitative
evaluation of feasibility & acceptability
Participants: 25 smokers aged >=18yrs with stage IV lung
cancer about to start chemotherapy treatment who agree to
try to stop smoking
Intervention: Provision of 2nd generation e-cig & liquid with
advice & support from experienced vaper whilst undergoing
cancer treatment; No control group
Key Outcomes: Feasibility & acceptability of stopping/reducing
smoking using e-cig; smoking cessation (CO verified)/reduction
at 12 weeks; perceptions of e-cig use & support offered
Challenges to Date (1)
NHS Ethics
Thoracic oncologist
interested in smoking
cessation
Oncology Team
Collaboration
Dr Stephen Harrow
and team at CRUK
funded Beatson West
of Scotland Cancer
Centre agreed to
collaborate
Challenges to Date (2)
Choice of e-cig
SmokeMax Power 1300
Challenges to Date (3)
Will any
patients be
interested?
Supporting
patients to use
e-cig &
overcome
barriers
Progress to Date
• Recruitment started 17th May
• About 6 eligible patients approached
•
4 patients (3 women, 1 man)
recruited & visited at home
to get started
• Further 1 patient referred to study
• Follow-up at 3 days so far
Questions?
[email protected]
Study Flow Diagram