The Risk Faced by CANCER PATIENTS Who Use E-Cigarettes!

The International Association for the Study of Lung Cancer (IASLC) is the world's largest multidisciplinary lung cancer organization. Combating tobacco useis important for reducing lung cancer incidence and improving outcomes in patients already diagnosed with cancer. In this context, IASLC issued a statement in November 2019. The statement says:

Why Are E-Cigarettes Concerning?

Electronic cigarettesrapidly gained popularity with claims that they could help people stop smoking and be less harmful than conventional tobacco products. Some people quit smoking using them, but use has now expanded substantially to nonsmokers, particularly adolescents and young adults. Cessation outcome data are inconsistent, and long-term risks remain unknown. A recently recognized, growing e-cigarette-related epidemic in the United States revealed potential vaping dangers when serious illness and deaths from pulmonary inflammation were reported in late 2019. Based on current evidence, IASLC shares international concerns and takes the following position on electronic cigarettes and other heated tobacco devices. We support the American Thoracic Society's stance and emphasize:

• Cancer treatment outcomes are worse in patients who continue smoking, and all physicians must support cessation through shared decision-making.
• All smokers, including those with cancer, should stop immediately by every possible means.
• Health professionals should advise all patients to stop smoking and vaping using evidence-based cessation aids.
• Safe, effective, evidence-based cessation aids include approved pharmacology and counseling.
• Electronic cigarettes are not proven smoking cessation products according to current systematic reviews.
• Several studies suggest a possible association between e-cigarettes and lung cancer in animal models; no studies yet assess human cancer risk. Studies linking vaping to cancer development will take several years to mature.
• Flavorings containing other additives used in e-cigarettes may increase vaping-associated illnesses.
• Electronic cigarettes should never be used by young people or adults who do not currently smoke.

The Risk of Cannabis E-Cigarettes for Young Cancer Patients

One major concern about new-generation e-cigarettes is that devices deliver not only nicotine but also tetrahydrocannabinol (THC, the psychoactive substance in cannabis). Some American states use medical cannabis to relieve pain in cancer patients. In young cancer patients, however, this perception may combine with vaping. Use of THC in e-cigarettes has concerned us since vaping began; recent findings that THC components used in e-cigarettes pose an EVALI risk make this more important.

What Is EVALI?

EVALI: mysterious lung injury associated with vaping (E-cigarette or VAping product use–associated Lung Injury).

EVALI, a mysterious vaping-associated lung disease, actually describes an inflammatory respiratory syndrome involving multiple organs (see news of e-cigarette-related deaths).

As is known, youth vaping has reached very high levels in America. As of 2019, more than 5,2 million young Americans (% 27,5 of high school students and % 10,5 of middle school students) use e-cigarettes. Given this situation and young cancer patients' familiarity with vaping, increased delivery of THC through e-cigarettes is considered a risk.

EVALI hospitalizations and deaths first appeared in June 2019 and peaked in September 2019. According to the US Centers for Disease Control and Prevention (CDC), by 21 January 2020 the USA had reported 60 deaths among 2711 EVALI cases. As of 14 January 2020, patients ranged from 15 to 75 years old, and the average age of those who died was 51.

In their Weekly Report published on 17 January 2020, CDC researchers stated that their agency, FDA, and state and local health departments determined that EVALI patients in Illinois, Utah, and Wisconsin obtained THC-containing products informally. As of 14 January 2020, % 82 of EVALI patients with a substance-use history reported recently vaping THC-containing products.

In conclusion, people using cannabis medically or recreationally are at substantial risk of EVALI, also considering potential exposure to vitamin E acetate. CDC emphasizes that no e-cigarette products containing vitamin E acetate or cannabis in particular should be used.