E-cigs knowledge gap leaves patients in dark

Patients facing surgery for lung cancer and coronary artery disease will increasingly need clearer clinical guidelines about the use of e-cigarettes

Australian clinicians need clear guidelines about e-cigarettes as a quit-smoking tool for patients facing surgery for lung cancer and coronary artery disease, new research shows.

A study of 52 clinicians at six Sydney hospitals found doctors and allied-health professionals were poorly equipped to advise perioperative patients about e-cigarettes and related regulations.

Study author Nia Luxton, a PhD candidate at Macquarie University, said demand for information would increase as the use of e-cigarettes was rising, but there was a gap in knowledge due to Australia’s cautious approach to e-cigarettes.

“I came out of these clinician interviews inspired, because they all care so deeply for each and every patient,” she said.

“There was a small handful of people saying, do whatever it takes to get them off (smoking), but the others said the reason we are uncertain about electronic cigarettes is that we care.

“They said, we don’t want this person to use an e-cigarette and then get a spasm in their coronary artery after surgery, or a weird reaction to anaesthetic during lung cancer surgery. We don’t know what it’s going to do to the patient.”

As a physiotherapist in London in the 1990s, Ms Luxton said the burden of disease from an “epidemic” of smoking was so bad at many UK hospitals that patients had to be sent to France for cardiac surgery.

More recently, in Australia, patients and family members were showing up with e-cigarette – or vaping – devices using nicotine, she said.

“What started me thinking about this was talking to (Australian) patients about their heart surgery or their lung surgery, and saying to them, so when do you stop smoking?” she told The Medical Republic.

“The majority of people would say 4 o’clock this afternoon, but there was a definite divide.”

The Sydney study she conducted in 2015-16 involved 52 surgeons, anaesthetists, physiotherapists and nurses.

“They don’t know much, but they are interested and they realise they have to be more prepared for these conversations. They realise it’s topical. They realise there is a gap,” she said.

“As with any smoking cessation, they need more time to deliver proper smoking cessation, more time to find out why a patient is interested in e-cigarettes.

“Is it because it’s a novelty, or because these patients are desperately trying to quit and they have tried everything else?”

Ms Luxton’s research paper is published in the November 7 edition of the International journal of Environmental Research and Public Health.