Smoking Is Related to Worse Cancer-related Symptom Burden

Abstract

Background Cigarette smoking is related to greater cancer incidence, worse cancer-related clinical outcomes, and worse patient quality of life. Few studies have evaluated the role of smoking in patients’ experiences of cancer-related symptom burden. This study examined relationships between smoking and total symptom burden as well as the incidence of severe symptoms among adult cancer patients. Patients and Methods Patients at Moffitt Cancer Center completed self-report surveys as part of routine cancer care. Symptom burden was evaluated as the sum of individual symptom ratings (total symptom burden) and the number of symptoms rated severe (incidence of severe symptoms). Zero-inflated negative binomial modeling was used to evaluate the relationships between smoking status (ever vs never smoker) and symptom burden outcomes controlling for relevant sociodemographic and clinical covariates and accounting for the proportion of participants reporting no symptom burden. Results This study included 12 571 cancer patients. More than half reported a history of cigarette smoking (n = 6771, 55%). Relative to never smokers, participants with a smoking history had 15% worse expected total symptom burden (ratio = 1.15, 95% confidence interval [CI] 1.11-1.20, P < .001) and 13% more expected severe symptoms (ratio = 1.13, 95% CI 1.05-1.21, P = .001) above and beyond the effects of relevant sociodemographic and clinical characteristics. Conclusion Results provide support that smoking is associated with worse cancer symptom burden. More research is needed to evaluate how smoking history (ie, current vs former smoker) and smoking cessation influence cancer symptom burden.

Tobacco use and cancer‐related symptom burden: Analysis of the US Population Assessment of Tobacco and Health Study

“…Indeed, it is possible that, for certain participants (e.g., those diagnosed with early stage disease, those many years posttreatment), the symptoms are entirely unrelated to cancer history. Nevertheless, the associations found between smoking status, symptom burden, and QoL in the current study align with those observed among patients who were assessed during cancer care by Oswald and colleagues (2022) after controlling for cancer site, stage, and treatment history using clinical information abstracted from internal cancer center databases 19 …”

“…By using a recently collected nationally representative US sample of 1409 cancer survivors, this study aligns with and extends previous research demonstrating that current smoking is associated with worse symptom burden and QoL among individuals with a history of cancer, 19,24,39‐41 and that individuals who formerly smoked report lower symptom burden and better QoL compared with those who currently smoke 40,41 . Indeed, in the current study, although past tobacco use was associated with worse pain and QoL compared with never using tobacco, there was no difference in fatigue or emotional problems between survivors with never and former smoking statuses.…”

“…The cross‐sectional design and lack of detailed information about prediagnosis functioning and QoL limit our ability to draw strong conclusions about the strength or directionality of the relationship between survivor or remission status, smoking, vaping, and symptom burden. The PATH data set also does not include cancer‐specific information that has been correlated with symptom burden, including cancer type, treatment status, time since diagnosis or treatment, cancer stage or severity, 49,50 or specific treatments received 19,49‐51 . It is possible that the strength of association between smoking and symptom burden differs by cancer type and stage, and we were not able to evaluate this in the current study.…”

“…Among a sample of 947 patients undergoing chemotherapy and/or radiation, current smoking was associated with significantly greater increases in total symptom burden during and 6 months after treatment 18 . A recent study of 12,571 patients with cancer found that current smoking and former smoking were associated with 15% worse symptom burden and 13% more severe side effects compared with never smoking 19 . With regard to specific symptoms, current smoking has been linked to greater pain intensity, 20–23 greater fatigue, 20,23,24 reduced appetite, 24 shortness of breath, 24 greater weight and hair loss, 18 concentration problems, mood disturbance, 18,23 and worse overall quality of life (QoL) 24 …”

Breast cancer: age incidence, hormone receptor status and family history in Najaf, Iraq

“…These factors may lead to ER-positive tumors or ER-negative tumors. Identifying families (multiple affected members whose tumors show concordant receptor expression) may allow the clarification of specific implementations that differentiate positive from negative receptor cancers [ 31 ].…”