Among Patients with Cancer, Smokers at Greater Risk for Opioid Misuse
(ChemotherapyAdvisor) – Patients with cancer who smoke have greater physical and psychological symptom reporting and appear to be at greater risk for opioid misuse than nonsmokers, results of a study presented during the American Academy of Pain Medicine 28th Annual Meeting have found.
“The full spectrum and intensity of symptom burden that we found among smokers and nonsmokers was not previously described in the literature,” investigators from the University of Texas M.D. Anderson Cancer Center, Houston, TX, noted.
Study participants were new patients at the institution's Pain Management Center who completed the Edmonton Symptom Assessment Scale (ESAS) and the Screener and Opioid Assessment for Patients with Pain (SOAPP) as part of their intake; 392 were nonsmokers and 94, smokers.
Mean age was 51.4 years in smokers and 55.6 years in nonsmokers. Cancer diagnoses include bone, brain/spine, breast, gastrointestinal, gynecological, head/neck, hematological, lung, skin, urogenital, and other. Among smokers, the most frequent diagnosis was head/neck cancer (22.3%), followed by breast cancer (14.9%), and gastrointestinal cancer (12.8%). Among nonsmokers, gastrointestinal cancer (19.9%) represented the most frequent diagnosis, followed by hematological cancer (16.3%), and head/neck cancer (12.8%).
Smokers had statistically significant worse usual pain intensity, fatigue, poor appetite, depression, anxiety, and insomnia than nonsmokers as well as more shortness of breath and difficulty thinking; however, these latter two differences were not statistically significant. Smokers also reported a history of current problems with mood swings, use of medication other than the way it was prescribed, use of illegal drugs, and legal problems more often than nonsmokers.
They caution that the unique characteristics of the patient sample must be take into account when interpreting these findings. The groups were not selected to be uniform across demographic and cancer diagnoses; the majority of new patients were on opioid therapy prescribed by their oncologists; and some had relocated to Texas for their cancer treatment, which can add to symptom burden. In addition, investigators were “unable to discern whether smoking may have increased pain or been motivated by the pain experience itself.”
“Matching treatment to the individual, with a careful consideration of smoking motivation and coping, should help clinicians maximize pain control and smoking-cessation outcomes in cancer settings,” they concluded.