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Hi all!
There’s been so much great discussion! We all seem to agree that vaping/e-cigarettes should be regulated just as traditional cigarettes are. I think this would be a positive step for public health as there really is no regulation for the contents of the vaping ‘liquid.’ I’ve heard about legislation to take some of the flavoring away (which can appeal to adolescents).
I did a quick review of the literature and found that vaping can lead to pulmonary complications. Patients have been seen in the ICU with ARDS symptoms and other such pulmonary complications. It’s definitely not a safe alternative to traditional smoking.
I’m glad to see interest in smoking cessation training. I will reach out to Christy and see if there’s further opportunity for this.
What do you all think is the biggest impact an oncology nurse can have on smoking cessation?
I agree 100% Jeff and I see new smoke shops popping up in my town and other small towns too!
Kelly- when they say “if I’m going to die anyway, I want to enjoy my life”-I want to so bad ask them why they are here(knowing how awful treatment makes them feel and the smoking pretty much guarantees bad reports), why not enjoy life smoking at home? Of course I do not and just provide support.
Hello, my name is Lynne Brophy and I am the breast cancer clinical nurse specialist and unfortunately, related to three people who vape and have serious, chronic mental illness.
What was the knowledge gained from the article? I absolutely loved reading the article by Essenmacher, et al. the psychiatric clinical nurse specialists! Even though it made me more nervous about my relatives, I thought the tips they offered about how to speak to patients about ENDs in table 3 was great. I was not surprised about the statistics regarding people with serious mental illness/ substance use disorder who use ENDS. I have seen this. I believe it.
How will this change my practice? My patients at risk for breast cancer or with breast cancer and a risk of relapse/recurrence need to quit smoking to decrease cancer risk but also to decrease the risk of cardiovascular disease after breast cancer treatment (chemotherapy and radiation therapy, especially on the left side). I would like to try inviting our team to think about using the wording in table 3 to talk to patients. Our revised clinical practice guideline on breast surgery will ask patients to abstain from tobacco use and vaping for four weeks before surgery…so I hope this will encourage us to use our nursing expertise to encourage patients to stop using ENDS (and tobacco).
What other questions does the article raise about current practice? Per Jeff’s comments, these articles have reminded me that it is CRITICAL for James nurses to get involved in some way with legislation regarding tobacco and END use. An easy way to do that is to go to The American Cancer Society’s Cancer Action Network, here: https://www.fightcancer.org/ Sign up to get more information. Then, if you wish you can provide lobbying via phone call, email or letters to legislators OR you can join us when we travel the Ohio State house next year in person for a few hours to educate and lobby with state legislators about cancer related topics. This year, we discussed the need to ban flavorings in ENDS in Ohio to decrease the risk of young people getting interested in using an END because they taste good and are more easy to conceal at home and school.
Do you agree/disagree with the conclusions of the author, why? I agree with the authors that ENDS have not been supported as methods to stop using tobacco and therefore should not be recommended as such. I think that nurses have the opportunity to provide brief tobacco/END cessation counseling to patients and remind them of the benefits of quitting even if they already have cancer. There is plenty of data that their pulmonary health will improve at least some if they quit, in addition to many other positive effects. We just need to remember that tobacco is harder to quit than cocaine so our patients MUST be referred to the tobacco cessation clinic for support. (It would be so nice if nurses worked in this clinic as tobacco cessation counselors.).
Per Kelly’s comment about banning ENDS where tobacco is banned, I believe the James has done this. But I am not sure everyone knows that noone should be vaping in a public place. Maybe more education is needed for employees at OSU? Wondering?
Lindsey and Renee, thank you SO MUCH for sponsoring this journal club. I really appreciate it and LOVE reading my colleague’s viewpoints.
Judy Moore RAD ONC JCBC
What was the knowledge gained from the article? That there is still a lot we do not know about the long-term implications of using ENDS. What is known is alarming and it is concerning that such a high percentage of patients continue to use the products after diagnosis.
Will the research/information in this article change or influence your practice? Yes, it will influence my practice. I will continue to discourage the use of inhalation products end encourage the use of smoking cessation programs.
What other questions does the article raise about current practice? Why are companies allowed to advertise these products? How long before there is enough scientific data to determine the long-term effects of prolonged on human use? How do we protect our vulnerable populations from even starting the use of the product?
Do you agree/disagree with the conclusions of the author, why? I agree that further research is needed so we have scientific data to support long-term health risks. What I find frustrating is the lack of a moral compass for these companies to develop and market a product to vulnerable populations probably knowing good and well that the products have the potential for causing harm.
Goodman10 – “I had no idea tobacco use remains the top preventable cause of illness and death around the world (Essenmacher et al., 2018).” And yet there are so many people in this world that still using these products. They are designed to be addictive, and I guess that is one of the reasons some cannot or are not willing to quit. Tobacco companies paid out a lot of money when they were finally taken to court about what they knew and when they knew about the harmful effects. Seems they are repeating the path with ENDS.
Lynn – “Our revised clinical practice guideline on breast surgery will ask patients to abstain from tobacco use and vaping for four weeks before surgery…so I hope this will encourage us to use our nursing expertise to encourage patients to stop using ENDS (and tobacco).”
I agree we need to encourage the patients to stop using these products. I think one of the barriers is that the patients do not think the ENDS products are harmful. So until her have the long-term research to determine the effect on health patients will continue to use.Hi All! My name is Holly Smith. I am in the outpatient float pool. Thanks Lindsay for leading the discussion!
1. Knowledge gained? I was surprised to learn that ENDS do not have to list the additive chemicals on the packaging and that they aren’t well-regulated by the FDA. Also, I wasn’t aware the Dept of Transportation banned e-cigarette use on airplanes, but allows passengers to carry them onto the plane. They also prohibit charging the batteries during flight. It seems bizarre to me that the DOT would allow this as we all know people love to break rules. Lastly, I was unaware there are so many variety of ENDS. Lastly, I know that tobacco products are big business, but it still boggles my mind that those companies are finding these new ways to get people hooked on something that is clearly bad for them. I remember my mother telling me that magazines in the 60s used to have ads stating “smoke cigarettes for your lung health”. This latest push to make E-cigs seem like they are a better alternative (without good research to back it up, I might add) is just another way to trick people into buying their products.
2. Will my practice change? I don’t believe it will. I advocate for “cold turkey” or weaning off smoking by decreasing the number of cigarettes over a period of time and having a plan in place prior to trying to stop.
3. What questions does this raise? Why aren’t ENDS more closely regulated? Are they more regulated in other countries? Why is benzene allowed to be in these when it is known to cause leukemias and other cancers?
4. Agree or disagree with authors? I agree that more research needs to be done and with as popular as ENDS are, it needs to be NOW. Especially since the tobacco companies seem to be targeting younger people.
Greg-I agree! It’s crazy that so many people are still using tobacco (and dying from it )after the clear link to cancers and breathing difficulties. Those companies are taking the same path with ENDS and probably will with whatever next new innovative nicotine delivery system they can come up with.
Jeff-I went to an ASCOT review in 2023 and one of the thoracic docs was advocating for use of ENDS to stop smoking. It really surprised me since right about that time there was a big surge in adolescents ending up in ICU with severe lung issues from vaping.
Hi! My name is Reena and currently I work in the endoscopy unit at East Hospital. I worked previously at the Stefanie Spielman in the surgical oncology unit.
The knowledge I gained from the articles was that the chance of receiving a cancer diagnosis was 15 times greater with the use of e-cigarettes than with prolonged smoking of regular cigarettes. In my opinion, when the e-cigarettes were first introduced as a way to help with smoking cessation and the appealing aspect of not smelling like cigarette smoke, I thought there has to be something worse being introduced into the body than smoke and that there couldn’t be a true way to know what a person is introducing into their body like with tobacco. After reading the article “E-Cigarettes and Smoking Cessation”, I learned that the chemical emitted was formaldehyde and we use this to suspend specimens into to send off to pathology.
Will the information gained change my practice? I already knew that e-cigarettes are not a better alternative to smoking cigarettes. I will still encourage my patients to stop using either real cigarettes or the e-cigarettes, but now I have more information on what the caustic effects are and what they are to provide to patients.
I agree totally that there is no way to actually know what amount of caustic material is being introduced into the person’s body when smoking the e-cigarettes, even if the cartridges state a certain amount. There should be a better type of regulation of quantitating the amount of what is in the e-cigarette. This is not to only be applied to nicotine, but also THC (since recreational marijuana use is legal in Ohio and probably more states to come).
Patricia,
You brought up a great point about the second hand exposure from e-cigarettes. I never thought about how that could impact those around the vape smoker. It was common knowledge that second hand cigarette smoke had the potential to cause health problems, but we do not know what the vape smoke may do to those around the vape smoker. We probably won’t know this for many years, but what a study to look for.Judy,
I can’t agree with you more about the lack of moral compass that these companies have with advertising the use of ENDS and targeting specific populations. My children grew up thinking that smoking was bad for your health and now as young adults think the vaping is a better option if someone were to choose to smoke to get the nicotine or THC. Of course I try to educate them on what I know, which wasn’t as much as the content of these articles, to hope that they don’t choose to take up vaping.I’m DeAnna and I work in the James After Hours Triage area.
1. I found both articles very educational for me as I have to admit I don’t really know much about ENDS devices. Unfortunately my kids tell me often that kids were found vaping in the school bathrooms, but I really don’t know anyone that does it so I haven’t really invested much thought into the devices. I did not realize these devices have been around for as long as they have been, almost 20 years! I have wondered how much better these devices really are compared to “regular” cigarettes, and in the end they aren’t!
2. I feel my practice changes would actually include more outside of my current nursing role in regards to talking more about ENDS devices with my kids. I feel ENDS devices are continuing to increase usage in the young population and maybe I can help that.
3. Why aren’t there regulations on these devices?! If these devices emit of the same secondary effects, why are we allowing them in the general public, in stores, at football games, etc.
4. Further studies need to be done with regards to second hand effects and long term health. I feel regulations should be set similar to “regular” cigarettes and we need to be education everyone more on what ENDS devices really are, what they are made up of and the second hand effects because I firmly believe people don’t put much thought into them because they don’t give off the “smell” like regular cigarettes do and they don’t think as much about it and how it affects them.
Mindy-I totally agree with you have the chemicals within ENDS products should be widely disclosed. Just like cigarettes, some people will still smoke them, but some will think twice when they see these ingredients. I think a lot of people don’t think there’s much of anything “bad” in them or think it’s “just” nicotin when there’s so much more in them! I didn’t even realize what all was in them! And I agree that most people don’t realize what’s really in some of the their foods, including me. I need to do a better job of looking and not eating/drinking some things I do!
Kelly- Great point brought up, about ENDS being a way to get the nicotin companies sales back up after the trend in smoking has decreased and their sales have decreased. 100% agree they know what they are doing with the fact ENDS are no better after reading these articles.
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