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

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

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

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

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

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

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

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

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

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

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

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

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

Questions? l.a.sinclair@stir.ac.uk

Study Flow Diagram