Smoking Cessation is Key but E-Cigarettes are Less Toxic, Preferable to Combustible Cigarettes

New York—In the face of declining cigarette smoking rates, the popularity of vapes and e-cigarettes has risen, and because of the associated risks for lung cancer, clinicians are wondering how to address this concern with their patients.

Laura Jean Bierut, MD, Alumni Endowed Professor of Psychiatry, Washington University of St. Louis, addressed this topic during her presentation at the 23rd Annual Perspectives in Thoracic Oncology meeting, and made it clear that while it is never too late for a clinician to encourage a patient to stop smoking, e-cigarettes may not be the worst fallback for cigarette smokers.

E-Cigarettes and Vaping

When talking electronic nicotine-delivering systems, Dr Bierut made it a point to stress that e-cigarattes are not approved by the FDA as smoking cessation devices.

Citing existing literature, she noted that e-cigarettes have much less potential to expel toxicity than combustible tobacco cigarettes, when used the standard way. In fact, she went so far as to quote conclusive evidence stating that “completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.”

Of note, in the United Kingdom, e-cigarettes are advertised as being far safer than smoking cigarettes. They are also associated with higher rates of smoking cessation and attempts to quit smoking.

Encouraging Smoking Cessation

In addition to being the largest cause of preventable death, cigarette smoking is responsible for more than 480,000 deaths in the United States annually. Although smoking has declined in recent years (down from 20.9% in 2015 to 15.5% in 2016), Dr Bierut stresses the need for proper documentation of patient smoking status in the electronic health record.

“Patient health records should be updated at regular intervals to indicate changes in smoking status, quit attempts made, and interventions utilized,” she said.

The use of pharmacologic combined with psychologic therapy is ideal, and is described as being the most efficacious approach to encouraging smoking cessation.

“The two most effective pharmacotherapy agents are combination nicotine replacement therapy and varenicline. High-intensity behavior therapy with multiple counseling sessions is most effective, but at least a minimum of brief counseling is highly recommended,” according to Dr Bierut.

She also encouraged the use of phone hotlines to help encourage cessation, including 1-800-QUIT-NOW.

No matter what stage of cancer a patient has, it is never too late for them to stop smoking.

“There are health benefits to smoking cessation even after a cancer diagnosis, regardless of stage or prognosis, namely improvement in cancer treatment outcomes, disease recurrence, and secondary cancers,” Dr Bierut said.

Clinicians should be encouraging their patients to use evidence-based methods to quit smoking cigarettes; however, switching to e-cigarettes is a reasonable alternative for those who cannot or simply don’t want to quit, she concluded.—Hina Khaliq