E-cigarettes as a Smoking Cessation aid in Cancer Patients: Health Professionals knowledge, attitude and current practice


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Jo Brett1,Fiona Matley2,Emma Davies1,Paul Aveyard3,Mary Wells4,David Foxcroft1,Brian Nicholson3,Lesley Sinclair5,Shiroma De Silva Minor6,Sarah Jakes7,Eila Watson1

1Oxford Brookes University,2Oxford Brooke University,3University of Oxford,4Imperial College Healthcare NHS Trust,5University of Stirling,6Oxford University Hospitals NHS Trust,7New Nicotine Alliance

Abstract

Background

The adverse effects of smoking continue after a diagnosis of cancer, increasing risk of treatment-related complications, recurrence, development of second primary cancer, and mortality. E-cigarettes have become increasingly popular, and there is growing evidence of a significant reduction in harm compared to tobacco smoking, providing an alternative approach for smoking cessation in cancer patients.  However, while Public Health England and the Royal College of Physicians support the use of e-cigarettes for smoking cessation, their use remains controversial.

Method

This study was a national online survey to investigate UK health professionals’ knowledge, attitudes, and current practice of e-cigarettes as a smoking cessation intervention in cancer patients. 506 health professionals (HPs) completed the survey including GPs (n=103), oncologists (n=102), cancer surgeons (n=100), practice nurses (n=102), cancer nurse specialists (n=99).  The sample was stratified by NHS regions.

Results

Twenty nine percent of HPs would not recommend e-cigarettes to cancer patients who smoke, with cancer surgeons and cancer nurse specialists significantly less likely to recommend e-cigarettes.  38% believed colleagues would feel uncomfortable about recommending e-cigarettes to cancer patients.  The majority of respondents reported that e-cigarettes were either banned or only allowed in designated tobacco smoking areas in both primary and secondary care.  46% of HPs reported their organisation did not have guidance on e-cigarettes, with 45% of HPs saying they were unsure. Over half of HPs believed their knowledge was not sufficient to recommend e-cigarettes to cancer patients, and 25% did not know whether e-cigarettes were less harmful than smoking tobacco cigarettes.

Conclusion

While UK health policy promotes e-cigarettes as a smoking cessation aid, this has not yet been adopted by local health organisations, causing barriers to and uncertainty around promoting use of e-cigarettes in cancer patients that smoke. Training of health professionals and local adoption of e-cigarette advice are needed.