A recent study published in the American Cancer Society’s journal Cancer found that among cancer patients who smoke cigarettes, those who smoke e-cigarettes are more likely to develop nicotine dependence and are less likely to quit traditional tobacco. The findings also raise questions about whether e-cigarettes are beneficial to the topic of smoking cessation in cancer patients. Because of the risks of continued smoking, all cancer patients who smoke should quit. But for patients and health care providers, do e-cigarettes help or hinder patients from quitting? The increased use of e-cigarettes is raising many questions, and even regulators are having headaches with this complexity when weighing the pros and cons of e-cigarette use in the general population and among cancer patients. To evaluate e-cigarette use and discontinuation among cancer patients, Jamie Ostroff et al. from Memorial Sloan-Kettering Cancer Center in New York studied 1,074 cancer patients who smoked in the Comprehensive Cancer Center’s tobacco treatment program in 2012-2013. The researchers found that e-cigarette use increased threefold (10.6%-38.5%) between 2012 and 2013, and that e-cigarette users were more nicotine-dependent, had more previous quits, and were more likely to be diagnosed with chest or head and neck cancer than non-users at the time of inclusion; at follow-up, e-cigarette users’ smoking status was not significantly different from non-users (OR=1.0 ; 95% CI, 0.5-1.7); intention-to-treat analysis found that e-cigarette users smoked almost twice as much as non-users (OR=2.0; 95% CI 1.2-3.3). In their conclusion, the researchers wrote, “The high rate of e-cigarette use in this study is consistent with the recent increase in e-cigarette use in the general population, and the findings call into question the topic of whether e-cigarettes are beneficial for smoking cessation in cancer patients. Further research is needed on the safety and efficacy of e-cigarettes as a treatment for smoking cessation in cancer patients.” The investigators concluded that oncologists should advise all smokers to quit traditional lightable tobacco, encourage patients to use FDA-recommended cessation treatments, and recommend that patients participate in smoking cessation counseling and be informed of the potential risks and lack of known benefits of long-term e-cigarette use.