All evidence points to e-cigarettes being an effective tool in helping smokers to quit, experts told the RCGP annual conference in Liverpool – but only if they are coupled with specialist support and complete cessation of tobacco use.
In a session on cancer care in general practice, GPs said smoking cessation was one of the most cost-effective ways GPs could help prevent cancer.
Dr Richard Roope, clinical lead for cancer at the RCGP and GP lead for Cancer Research UK, said it could save £9 for every £1 spent over a person’s lifetime in health cost savings, and every £1 spent will pay itself back within five years.
He warned general practice was facing a perfect storm on cancer as the population ages and life expectancy rises.
This is paired with lifestyles factors such as poor diet and smoking, which had helped push cancer incidence to a new milestone of 1,000 people diagnosed every day in the UK by the end of 2016.
But Wandsworth GP Dr Alex Bobak, one of the first GPs to become a GPSI in smoking cessation, warned that simply advising smokers to quit is not the best course of action.
He said: ‘It’s negative – it doesn’t matter how you dress it up. It’s nagging, nothing new – and it encourages conflict and denial.
‘You're dealing with someone who is likely an addict. If you directly push a contrary view to an addict, denial will kick in and you’ve lost them. It’s frustrating, it takes longer, and it puts you off doing it again.’
Facilitating access to support from trained advisers alongside prescribing pharmacotherapy is the key to maximising success, he said.
With willpower alone, only around 3-5% of patients manage to succeed in quitting. With support from a trained adviser, this increases to 10-15%. And this doubles to 20-30% if used in combination with pharmacotherapy.
‘But less than 4% of quit attempts are going through that route – which means tiny numbers are having anything like optimum treatment,’ said Dr Bobak.
Dr Linda Bauld, a professor of health policy at the University of Stirling, said that the current consensus favoured use of e-cigarettes as a quitting aid.
And evidence suggests they are used almost entirely by ex-smokers and current smokers – and only very small numbers of never smokers, she said – implying they do not act as a gateway to tobacco use.
‘The crucial message is that e-cigarettes are hugely safer than tobacco – but patients won't realise any health benefits unless they switch entirely to vaping and stop smoking cigarettes completely,' she said.
‘We should see very encouraging results for smoking cessation. If used every day and with high concentration, these products can help people move away from smoking.’
Dr Bobak said e-cigarettes were a ‘phenomenal quitting aid’ – simply because patients ‘really like them’.
‘We do not know the long-term risk – although they are likely to be minimal,’ he said. ‘But we do know short-term risks – which are minimal, and similar to NRT. Smokers want choice, and many want to use it – for goodness’ sake let them.
‘It’s a fantastic opportunity, but not being used right. It’s not been given with support, and 40% use e-cigarettes alongside smoking. We should be clear that you use them with absolute cessation of combustible tobacco.’
Dr Roope added that e-cigarettes were a ‘very exciting area’ and 'will have a huge role to play in cessation in the future'.