February 18, 2019
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E-cigarette use rises among patients with cancer

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Rates of electronic cigarette use among patients with cancer have risen over the past several years as rates of conventional smoking have remained steady, according to survey results reported in a research letter published in JAMA Oncology.

“[E-cigarettes] have become increasingly popular in the United States and are advertised as a potentially safe and useful method of smoking cessation, despite unknown long-term health sequelae,” Nina N. Sanford, MD, assistant professor in the department of radiation oncology at University of Texas Southwestern Medical Center, and colleagues wrote. “Individuals with cancer are particularly sensitive to the harms of active smoking, thus smoking cessation is a critical component of cancer survivorship. However, the patterns and implications of e-cigarette use in patients with cancer are not well-known.”

Researchers analyzed smoking habits and e-cigarette use among 13,274 adults with cancer (median age, 68 years; range, 18-85) who participated in the National Health Interview Survey between 2014 and 2017.

Among all the participants, 1,259 (9.5%) reported using e-cigarettes.

Results showed that from 2014 to 2017, the rate of e-cigarette use increased from 8.5% to 10.7% (P = .01), whereas the rate of conventional smoking remained steady, from 50.7% to 51.9%.

“This is a relatively short time period and the database we used does not accurately capture quantity of smoking, so perhaps cancer patients and survivors are smoking less, but not none,” Sanford told HemOnc Today. “Either way, the stable rates of conventional smoking does cast doubt that e-cigarettes are an effective method of smoking cessation in this population.”

The years 2016 and 2017 appeared associated with increased odds of e-cigarette use (adjusted OR [AOR] = 1.26; 95% CI, 1.01-1.57).

Patients aged younger than 50 years had higher odds of using e-cigarettes (AOR = 3.79; 95% CI, 2.86-5.03).

Researchers observed the association between e-cigarette use and higher likelihood of use for years 2016 and 2017 among patients younger than 50 years (AOR = 1.71; 95% CI, 1.17-2.51) but not in patients age 50 years or older (AOR = 1.05; 95% CI, 0.82-1.35).
E-cigarette use between 2014 and 2017 increased from 22.8% to 26.8% in patients aged younger than 50 years and from 6% to 8% in patients aged 50 years and older. E-cigarette use among former smokers increased from 5.8% to 8.3% during this period.

“I am concerned that e-cigarette/vaping use will continue to increase among younger folks. First, because they can contain nicotine, which is highly addictive, so those who have already started using them are likely to continue,” Sanford told HemOnc Today. “Second, [I am concerned by] the attractive marketing tools employed specifically to entice the younger population. I think their popularity will continue to increase until there is documented evidence of their long-term harm — either directly from e-cigarettes, or from e-cigarettes as a gateway to conventional smoking.”

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Most of the participants were white, and the data were self-reported, which served as limitations to this study.

“Among the general population, experts worry that e-cigarettes may be creating addiction to nicotine among younger individuals who are at risk of prolonged exposure,” Sanford and colleagues wrote. “Our findings prompt similar concerns regarding potential deleterious long-term consequences on oncologic outcomes and survivorship, including the potential for increased cancer risk, for which further investigation is needed.” – by John DeRosier

For more information:

Nina N. Sanford, MD, can be reached at Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390-9303; email: nina.sanford@utsouthwestern.edu.

Disclosures: The authors report no relevant financial disclosures.