Background:
Many patients diagnosed with lung cancer continue to smoke even though this can make their treatment less effective and increase side effects. E-cigarettes form part of the UK's tobacco harm reduction policy landscape and are, by far, smokers' most popular quit attempt method. This pilot study explores feasibility and acceptability of e-cigarettes to aid smoking cessation among lung cancer patients undergoing chemotherapy.

Methods:
27 smokers with stage IV lung cancer were recruited from one NHS site in Scotland between May-16 and June-17. They were provided with a 2^nd generation e-cigarette kit at a baseline home visit conducted by a researcher and a volunteer who was an experienced e-cigarette user. Participants were followed-up weekly for four weeks and at 16 weeks. Participants´ response to, and use of, e-cigarettes was explored along with cessation outcomes (self-reported and CO verified). In-depth qualitative interviews were conducted with health professionals (n=8) engaged with lung cancer patients to obtain their views on the study.

Results:
Overall, participants were motivated to stop smoking and took easily to using e-cigarettes. Minor issues arose around choice of flavour, and some side effects were noted, although participants reported difficulty in distinguishing these from treatment side effects. Seven participants were lost to follow-up. Preliminary findings show that at 4-week follow-up: average CO reading had reduced from 14 (range 3-37) to 8 (range 1-29), and 70% of participants reported daily e-cigarette use, however, use was dependent on individuals' day-to-day health. Health professionals interviewed were generally supportive of e-cigarettes as a tool for quitting, and suggested future efforts should concentrate on patients with curable cancer.

Conclusions:
E-cigarettes have a potential role to play for lung cancer patients. Future smoking cessation research should take account of the impact of cancer treatment on emotional and physical health and explore e-cigarette use among patients with earlier stage lung cancer.