E-Cigarettes to Stop Smoking: Does It Work?

Should We Recommend E-Cigarettes to Help Our Patients Stop Smoking: Does It Work?
Cary Presant, MD, Oncology, Hematology/Oncology, 09:05PM May 25, 2015


Smoking is a problem in our patients, since continued smoking produces worse outcomes in colorectal cancer survivorship. Also, it leads to increased cancer mortality and cardiovascular mortality. And we are often asked by our patients about what we suggest for helping in smoking cessation. These questions usually include inquiries about recommendations for or against use of e-cigarettes (also called ENDS – electronic nicotine delivery systems).



A recent article by TH Brandon and coauthors (J Clin Oncol 2015; 33: 952) gives a good overview of ENDS and their benefits (or lack thereof). It also includes the ASCO policy recommendations.



I was most impressed by the low effectiveness of use of ENDS in helping patients to stop combustible cigarette use. In Table 2, the largest trials were surprisingly unsuccessful in helping patients. In the largest trial of 6000 patients, quit rates were highest for ENDS users 20%, only slightly higher than 15% in controls and 10% in nicotine replacement therapy. In the second largest reviewed trial, in 5939 patients, 85% of ENDS users were using them to quit smoking, and surprisingly the 11% rate of successful quitting was no higher than in patients not using ENDS.



I have been recommending that patients may try ENDS (and many of my friends and patients have succeeded in quitting with the “help” of ENDS), but now I need to be careful in setting their expectations appropriately. This review by ASCO and the well-articulated policy statement will help in my ability to take care of my patients.



I recommend you read the review and think about how you, an expert in the outcomes of smoking, can use this information in promoting healthier habits in your patients, among your colleagues and PCPs, in your community, and even in your families.