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SMOKING CESSATION AND VAPING2019 Lung Cancer SymposiumLisa Fuchs, MHA, RRT, CTTS, CHWC
KEY LEARNING
• Traditional smoking cessation methods
• The different types of vaping products
• How e-cigarette products threaten public health as gateways to nicotine addition for new or dual smokers
• Mysterious vaping respiratory illnesses across the United States
THE RELATIONSHIP BETWEEN SMOKING AND CANCER
• One third of all cancers are smoking-related
• Smoking is related to at least 12 types of cancer
• 2.5 million people die worldwide/year as a result of smoking
Source: Surgeon General’s Report, 2014
SMOKING CESSATION AND THE CANCER PATIENT
Per the National Comprehensive Cancer Network (NCCN) Guidelines
Tobacco treatment plans for all smokers with cancer should include:
• Evidence based pharmacotherapy
• Behavior therapy (counseling)
• Close follow-up with retreatment prn
• Pharmacotherapy can be effected and is recommended
CANCER TREATMENT
Contemporary clinical
trihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035625/
als, 50, 54–65. doi:10.1016/j.cct.2016.07.016
SMOKING CESSATION APPROACH
• Tailor the treatment
• Co-ordinate a TTS with other appointments
• With permission of the patient… include care-givers into a follow up plan
• Adjust based on oncology treatment plans and care plan time-line
• Tailored motivational counseling support
• The Cancer Patient Tobacco Use Questionnaire (C-TUC)
• https://cancercontrol.cancer.gov/brp/tcrb/documents/C-TUQ_Flyer_Questionnaire-508.pdf
Mayo Clinic Conference- Dr. Thulasee Jose, MD
TRANSDERMAL NICOTINE REPLACEMENT PATCH
• Consider the disease or treatment related skin condition/integrity (example: graft vs host disease)
• Rapid cell- cycle turnover during oncology treatment
• Patch adherence to skin hint use surgical tape to cover patch
NICOTINE REPLACEMENT GUM/LOZENGE/INHALER
• Oncology treatment related mucositis
• Surgical resection of head/neck
• Head neck radiation
• Disease related to dysphagia
Tailor the NRT or consider a medication to assist with cessation.
THE BENEFITS OF CANCER PATIENTS QUITTING
• Improve outcomes after radiation, chemotherapy, and surgery
• Improve quality of life in survivorship
• Improve quality of life in survivorship
• Reduce the risk of subsequent cancers
• Decrease symptom burden during treatment
Peppone, l.j., Mustian, K.M., Morrow, G.R., Dozier, A.M.,Ossip, D.J.,Janelsins, M.C.,…& McIntosh, S.(2011). The effect of cigarette smoking on cancer treatment-related side effects.The oncologist, 16(12), 1784-1792.
Vaping Devices
ANATOMY OF AN ELECTRONIC CIGARETTE
ENDS EVOLUTION
CONTENTS OF THE E-LIQUID
VAPING SMOKE PLUMES
MODS PODS
JUUL
POD SYSTEM
POD POD System Coil
MODS SYSTEMS
MODS Heated coils
UNITED STATES E-CIGARETTE SALES 2013-2017
E-CIGARETTES AND RISKS
• Brain is still developing until age 25
• Addiction
• Behavior risks
• Dual smoking
• Aerosols and other risks
5 VAPING FACTS – JOHNS HOPKINS
1. Vaping is less harmful than traditional smoking
2. Vaping is still bad for your health
3. Electronic cigarettes are just as addictive as traditional cigarettes
4. Electronic cigarettes are not the best smoking cessation tool
5. A new generation is getting hooked on nicotine
https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping
RECOMMENDATIONS FOR CLINICIANS - REPORTINGE-CIGARETTE OR VAPING ILLNESSES
• CDC encourages reporting pulmonary diseases associated with vaping
• Report cases of unknown etiology
• Ask patients about vaping history within the last 90 days
• Detailed History and Physical
• Testing e-juice
• Rule out other possible causes of pulmonary illness
PUBLIC HEALTH EPIDEMIC
VAPING RELATED TO A NEW RESPIRATORY DISEASE
• Mysterious respiratory illness affecting young people
• THC and Vitamin E
• CDC investigating nearly 150 – 1,479 cases
• 33 deaths have been confirmed in 24 states
• States pulling flavored e-juice to deter teens from vaping
• Summary on Morbidity and Mortality Report
SCANS OF LUNG DAMAGE RELATED TO VAPING
SUMMARY
• Traditional tobacco cessation, along with counseling does work with cancer patients.
• We don’t understand the long term effects of vaping related to cancer
• However, vaping can be linked to certain cancers such as, lung, oral, and bladder.
• In 2018 animal study suggest nicotine from an e-cigarette vapor can:
• Damage DNA
• Limits DNA repair
• Enhances cell mutation
• The EPA suggest that “acrylonitrile” as a “probable human carcinogen.” (e-juice)
https://www.healthline.com/health/can-vaping-cause-cancer
WEBSITE REFERENCES
• https://www.cdc.gov/mmwr/index.html
• https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html#can-using-e-cigarettes-lead-to-cigarette-smoking
• https://e-cigarettes.surgeongeneral.gov/knowtherisks.html
• https://www.hhs.gov/about/news/2019/09/11/trump-administration-combating-epidemic-youth-ecigarette-use-plan-clear-market.html
• https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vapinghttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035625/
• https://www.vox.com/science-and-health/2019/3/28/18277658/vaping-health-effects-vs-smoking
