Electronic cigarettes gave a lot of optimism to heavy smokers, including those unfortunately affected by cancer. The positive views shared by oncologists like Dr. Umberto Veronesi and his colleagues raise hopes that finally kicking the vice for good is possible. A damning evidence making the headlines stating that “E-cigarettes (are) unhelpful in smoking cessation among cancer patients” does not only question the possible benefits of the device for helping cancer-afflicted patients quit the habit; it is also killing the budding hopes of these people.
For the purpose of life saving and sustaining the hopes of cancer patients and vulnerable smokers, it is pivotal to assess the soundness of the study supporting such negative findings. In the light of conflicting views among major stakeholders – tobacco and E-Cig business corporations, health organizations and medical experts – these sweeping conclusions need to be scrutinized and re-evaluated to make sure e-cig antagonists are not just pulling wool over everyone’s eyes.
The Facts of the Study
- The Objective: The study aims to: “Determine whether or not cancer patients who’ve used e-cigarettes are more or less likely to quit smoking than those who haven’t, and also look at differences in their characteristics.”
- The Methods: There were 1,074 cancer patients that were used as subjects in the study selected from those enrolled in a tobacco treatment program at a cancer center. The selection was based on an assessment based on history of tobacco use, standard demographic factors as well as follow-up cessation results.
- The Findings: There was an observation that there was a threefold growth in the use of electronic cigarettes from 10.6% to 38.5% during the study (2012 to 2013). The e-cig users manifested greater nicotine dependence, had more attempts to quit smoking, and were mostly diagnosed with cancers in the head, neck or thoracic region. A case analysis revealed that e-cig users were mostly still smoking during the follow-ups and intention-to-treat analysis showed that these users were twice as likely to be still smoking during the follow-up comparable to nonusers. These observations mean that there was “no significant difference in the quit rate or odds of still smoking between e-cig users and non-users.”
- The Conclusions: The rate of e-cig use is not different at all in comparison to the general population. The observations “raise doubts concerning the usefulness of E-cigarettes for facilitating smoking cessation among patients with cancer.” The researchers recommend further studies to assess the safety and efficacy of e-cigs as a cessation treatment for people afflicted with cancer.
Questionable Elements of the Study
- Who made it as participants of the study: In the full report, participants were selected based on their response to the question: Did you use e-cigarettes in the last 30 days? All those who answered in the affirmative were readily classified as “e-cig users.” Clearly, the participants in the study were selected based on their failure to kick smoking using electronic cigarettes; not a sound premise at all.
The Flaw: The method of selection made sure that participants have tried e-cigarettes, but are still smoking making them highly dependent smokers. Thus, participants all fall under the category of “failed quitters.” Those who tried and succeeded did not make it to the study being labeled as “not eligible to participate.” Wouldn’t have it been without bias if the researchers used a random selection method among all the cancer patients in the center (or more centers to further eliminate other variables) with both experiences of smoking and vaping?
A professional Opinion: Dr. Michael Siegel observed that if there were hypothetically 1000 potential participants in the cancer center, and 900 have successfully kicked the vice with e-cigarettes, only those 100 “tough nuts to crack” made it as subjects of the study. In other words, the biased selection process is already expected to cause results to skew in favor of “e-cig use not being helpful at all” from the start of the study.
- The frequency of the assessment: The use of e-cigarette was determined just once at the initial stage of the study. A follow up was made only after 10 months to find out if the subjects were still smoking, if they smoke (even a single puff) in the previous week, if they have gone a full day without smoking during the 10-month study, and if they smoked, how many sticks of cigarettes they smoked.
The Flaw: While the questions (and the answers) were relevant, these did not provide an accurate picture of the attempt and the degree of success or failure. If the patient successfully avoided smoking except for a puff in the week before the final assessment upon which the results were based, it is not indicated in the final report. All that was said was that “the e-cigarette users tried vaping, but continued to smoke (meaning failed). Further, there should have been periodic assessments made in the duration of the study to make the results credible.
- No-show participants labeled as “still smoking”: Those subjects who did not show up for the second or final assessment were considered as “still smoking” or removed from analysis. Further, statistical analyses were used to determine the significance of the differences between the observations between the users and non-users.
- The Flaw: Those who failed to appear during the assessment should not have been categorized as “still smoking” as this will affect the validity of the final quantitative analyses. This is a detail worth noting especially so that they used statistical tests to determine the significance of their hypotheses. While statistical tests can soundly ascertain significance in a set of values, it is so only if there has been no biases committed in the process of selection or designing the experiment. Statistics also has limitations; there are occasions when it can mar results than provide enlightenment.
- Both groups were given the same treatment. The e-cig users and non-users were provided with similar treatment so it is likely that they will show quite similar quit-rates. The subjects were not also given any further intervention.
The Flaw: The similar quit rates were not really surprising considering that the treatments provided were just the same and with the only prior e-cig use as the variable.
Alternative Understanding of the Findings
Even without any further deep analyses, it is apparent that the study’s conclusions and recommendations are generally one-sided. One can’t help but entertain the possibility that the decision to use those who already tried and failed quitters as subjects in the study was purposeful.
You don’t need a scientific or medical background to wonder why the highly educated five researchers (with PhDs) behind this study came up with such flawed study. Aren’t they supposed to see all these flaws first-hand and reconsider their statements following their release of the results? What was their agenda? Can you smell politics reeking all over the issue?
Photo Credit: Joseph Morris – Flickr