HOP Researcher Says Study Documenting E-Cigarette Use Among Cancer Survivors Raises Concerns

As use of electronic cigarettes becomes increasingly popular in the United States, a team of researchers led by Ramzi Salloum, Ph.D., in the Department of Health Outcomes & Policy, has found that even certain vulnerable populations, such as cancer survivors, now use them.  The researchers found that while cancer survivors are less likely than the general population to smoke e-cigarettes—2.8 percent of cancer survivors use e-cigarettes, compared to 3.8 percent of the general population—e-cigarette use still is quite common in this group, especially among cancer survivors who smoke.

“Use of Electronic Cigarettes Among Cancer Survivors in the U.S.,” published in the November 2016 issue of the American Journal of Preventive Medicine, is the first study to provide estimates of e-cigarette use among cancer survivors from a nationally representative sample. The research team examined the prevalence of e-cigarette use among 2,695 cancer survivors with data from the 2014 National Health Interview Study, which provides information on a variety of health topics from 36,424 survey respondents nationwide. Other researchers on the team include Kayla R. Getz, research coordinator in UF’s Department of Health Outcomes & Policy; Thomas J. George, M.D., medical director of UF’s GI Oncology Program; and Elizabeth A. Shenkman, Ph.D., chair of the Department of Health Outcomes & Policy and director of UF’s Institute for Child Health Policy.

Salloum’s team found that 15.6 percent of cancer survivors who currently smoke cigarettes also use e-cigarettes. Another 34.3 percent of cancer survivors who currently smoke reported having used e-cigarettes in the past. Younger cancer survivors were more likely to have ever used e-cigarettes than those 65 and older, and female cancer survivors were more likely to use e-cigarettes than males.

Salloum, whose research focuses on understanding individual choice in cancer prevention and control, said the study findings raise several concerns about e-cigarette use among cancer survivors.

“It’s possible we are seeing such high rates of e-cigarette use among survivors who are smokers because of the perception that e-cigarettes are less harmful,” he said. However, the jury is still out on the long-term health effects associated with e-cigarettes.

Salloum added that some cancer survivors who smoke may be turning to e-cigarettes because of a belief that e-cigarettes and other electronic nicotine delivery systems (ENDS) can help them quit. However, he said there currently is no evidence that e-cigarettes will help smokers quit.

In fact, some public health experts fear that e-cigarettes could potentially encourage nicotine addiction in non-smokers who use them and prolong the addiction in people who want to quit smoking.  For this reason, in 2015, two organizations—the American Society of Clinical Oncology and the American Association for Cancer Research—issued a joint policy statement advising oncologists to recommend FDA-approved smoking-cessation medications instead of e-cigarettes to patients who smoke cigarettes and want to quit.

“What is abundantly clear is that a portion of cancer survivors who smoke are using e-cigarettes, and none of the smoking cessation strategies aimed at cancer survivors address their use,” Salloum said.