SMOKING CESSATION AND VAPING - Learning Stream1. Vaping is less harmful than traditional smoking 2. Vaping is still bad for your health 3. Electronic cigarettes are just as addictive

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

• https://www.youtube.com/watch?v=OpkCcrrYf6s

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

THANK YOU

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