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Nurses ‘reluctant’ to recommend e-cigs to smoking cancer patients

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Clearer guidance and training is needed at local level for health professionals on the endorsement of e-cigarettes to cancer patients who smoke, according to the authors of a UK study.

Based on their research, they found around 30% of health professionals would not recommend e-cigarettes to cancer patients who were smokers.

“These results suggest that there’s a lack of clear policy on e-cigarettes at the local level”

Jo Brett

This was despite the fact that national public health guidelines listed e-cigarettes as a less harmful substitute to smoking, the researchers noted.

They highlighted that both Public Health England and the Royal College of Physicians had given their support to e-cigarettes as less harmful alternatives to regular, despite their relative health risks.

An independent e-cigarette evidence review was published in February this year by PHE, which led the body to recommend to trusts that e-cigarettes, alongside nicotine replacement therapies, were available for sale in hospital shops.

The Royal College of Physicians had also concluded in a 2016 report – titled Nicotine without smoke: Tobacco harm reduction – that e-cigarettes were “likely to be beneficial to UK public health”.

But the authors of the new study stated that this national support for e-cigarettes was not commonly known at a local level among clinicians who regularly interacted with cancer patients, including both specialist nurses and practice nurses.

The study comes in light of the evolving debate on e-cigarettes in recent years, which has largely seen guidance come down in favour of them as a safer alternative to traditional tobacco products.

The Oxford Brookes University researchers surveyed 506 health professionals, comprising 103 GPs, 102 oncologists, 100 cancer surgeons, 103 practice nurses, and 99 cancer nurses.

“It suggests doctors and nurses need better information and clearer policies to guide their discussions with patients”

Linda Bauld

The survey included questions on knowledge of e-cigarettes, hospital policies on e-cigarettes, and whether the participant would recommend them to cancer patients who smoke.

Out of the 506 professionals, 29% said they would not recommend e-cigarettes and over half said they did not know enough about e-cigarettes to be able to recommend for or against their use.

The study also found that 46% of respondents claimed that clear guidance was not provided by their hospital or clinic.

The findings were presented last week by senior research fellow Dr Jo Brett at the National Cancer Research Institute’s 2018 Cancer Conference in Glasgow.

Dr Brett said: “These results suggest that there’s a lack of clear policy on e-cigarettes at the local level. They also suggest a lack of awareness of existing evidence and national policy on e-cigarettes among doctors and nurses.”

Smoking while being treated for cancer increased risk of complications, recurrence and the development of a second primary tumour, warned Dr Brett.

She highlighted that e-cigarettes were “now the most popular intervention for smoking cessation in the UK”.

Hospitals and clinics must develop policies on e-cigarettes and health professionals must be given the evidence and policy on e-cigarettes, she added.

Professor Linda Bauld, a public health expert from the University of Edinburgh and member of the NCRI’s Cancer Conference Scientific Committee, supported Dr Brett’s recommendations.

“Although we have evidence to show that e-cigarettes are a substantially less harmful alternative to smoking tobacco for cancer patients, this survey highlights that not all health professionals know this,” she said.

“They are unsure how to talk to cancer patients who smoke about e-cigarettes,” she said. “It also suggests that doctors and nurses need better information and clearer policies to guide their discussions with patients.”

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