Abstract
Although many cancer patients who have pain are smokers, the extent of their symptom
burden and risk for opioid misuse are not well understood. In this study we analyzed
records of patients being treated for cancer pain, 94 of whom were smokers and 392
of whom were nonsmokers, to determine smoking status group differences. Smokers had
significantly higher pain intensity, fatigue, depression, and anxiety than nonsmokers
(independent samples t-tests P < .002). Smokers were at higher risk for opioid misuse based on the short form of
the Screener and Opioid Assessment for Patients with Pain (SOAPP). Specifically, smokers
had more frequent problems with mood swings, taking medications other than how they
are prescribed, a history of illegal drug use, and a history of legal problems (chi-square
tests P ≤ .002). Changes in pain and opioid use were examined in a subset of patients (146
nonsmokers and 46 smokers) who were receiving opioid therapy on at least 2 of the
3 data time points (consult, follow-up 1 month after consult, follow-up 6 to 9 months
after consult). Results based on multilevel linear modeling showed that over a period
of approximately 6 months, smokers continued to report significantly higher pain than
nonsmokers. Both smokers and nonsmokers reported a significant decline in pain across
the 6-month period; the rate of decline did not differ across smokers and nonsmokers.
No significant difference over time was found in opioid use between smokers and nonsmokers.
These findings will guide subsequent studies and inform clinical practice, particularly
the relevancy of smoking cessation.
Perspective
This article describes pain, symptom burden, and risk for opioid misuse among cancer
patients with pain across smoking status. Smoking appears to be a potential mechanism
for having an increased pain and symptom burden and risk for opioid misuse. This improved
understanding of cancer pain will inform clinical practice.
Key words
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Article info
Publication history
Published online: September 25, 2012
Accepted:
July 30,
2012
Received in revised form:
July 5,
2012
Received:
April 26,
2012
Footnotes
The study received funding from the MD Anderson Cancer Center Support Grant, NCI CA 16672.
No conflict of interest exists for any of the authors.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
