1. E-cigarettes for lung cancer patients
UKNSCC London 2016
E-cigarettes for lung cancer patients
Lesley Sinclair
on behalf of study team

2. Outline Background Aims of objectives Methods Challenges to date
Progress so far

3. 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

4. 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

5. 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

6. 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

7. 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

8. Inform future trial on benefits to survival & QoL
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

9. 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

10. Oncology Team Collaboration
Challenges to Date (1)
NHS Ethics
Oncology Team Collaboration
Thoracic oncologist interested in smoking cessation
Dr Stephen Harrow and team at CRUK funded Beatson West of Scotland Cancer Centre agreed to collaborate

11. Challenges to Date (2)
Choice of e-cig
SmokeMax Power 1300

12. Challenges to Date (3) Will any patients be interested?
Supporting patients to use e-cig & overcome barriers
Public involvement has important role to play in any study, but proving particularly crucial for this one
Quickly realised need experienced vapers to support patients to understand how to use e-cigs (particularly the 2nd gen device chosen) & help overcome barriers to continued use for cessation
Approached the New Nicotine Alliance (a registered charity) who are now actively involved in the study through their lead in Scotland, Andy Morrison
The NNA (Andy Morrison) recruited team of experienced volunteer vapers living in NHS GGC to assist
They have met with our team and will be accompanying us on home visits to patients
They have detailed guidance to follow and have been briefed on patient confidentiality and other appropriate processes & procedures
Andy set up a closed Facebook group for us & the volunteers

13. 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

14. Questions?

15. Study Flow Diagram