Association Between Tobacco Use, Symptom Expression, and Alcohol and Illicit Drug Use in Advanced Cancer Patients.

Abstract

CONTEXT:

Limited knowledge exists examining the association between smoking status, symptom expression, and alcohol or illicit drug use.

OBJECTIVES:

The goal of this study was to clarify these associations in patients with advanced cancer.

METHODS:

We retrospectively reviewed 560 charts and identified 300 consecutive advanced cancer patients who completed a comprehensive smoking questionnaire. Data including the Edmonton Symptom Assessment System, Cut down/Annoyed/Guilty/Eye opener (CAGE) alcoholism screening questionnaire, illicit drug use history, and daily opioid requirements-morphine equivalent daily dose-were collected.

RESULTS:

Among 300 patients, 119 (40%) were never smokers, 148 (49%) former smokers, and 33 (11%) current smokers. The most common malignancies were gastrointestinal (28%) and lung (20%). Current smokers were more likely to be single (P < 0.01) and significantly younger than former smokers (P < 0.001) but did not differ in age from never smokers. Never smokers were more likely to be female (P < 0.001). Current smokers reported significantly higher pain expression than former and never smokers (median 7 vs. 5.5 vs. 5, respectively, P = 0.02), higher CAGE positivity (42% vs. 21% vs. 3%, P < 0.001) and were more likely to have a history of illicit drug use (33% vs. 16% vs. 3%, P < 0.001). The morphine equivalent daily dose was not significantly different according to smoking status.

CONCLUSION:

In advanced cancer, patients who were former or current smokers were significantly more likely to have a history of CAGE positivity and illicit drug use compared with never smokers. Current smokers expressed significantly higher pain. A smoking history may be a marker of an increased risk of opioid misuse.

• Authors: Yu Jung Kim, Rony Dev, Akhila Reddy, David Hui, Kimberson Tanco, Minjeong Park, Diane Liu, Janet Williams, Eduardo Bruera
• Journal: Journal of pain and symptom management (J Pain Symptom Manage) Vol. 51 Issue 4 Pg. 762-768 (Apr 2016) ISSN: 1873-6513 [Electronic] United States
• PMID: 26703372 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Published by Elsevier Inc.

Chemical References

• Analgesics, Opioid
• Illicit Drugs

Topics

• Adaptation, Psychological
• Age Factors
• Alcohol Drinking (physiopathology)
• Analgesics, Opioid (therapeutic use)
• Cancer Pain (drug therapy, epidemiology, physiopathology)
• Female
• Humans
• Illicit Drugs
• Male
• Marital Status
• Middle Aged
• Neoplasms (epidemiology, physiopathology)
• Retrospective Studies
• Severity of Illness Index
• Substance-Related Disorders (epidemiology, physiopathology)
• Tobacco Use (physiopathology)