What’s the relationship between cancer survivors’ tobacco use, symptom burden, and motivation to quit smoking?

In a recent study, current smoking and vaping were associated with a higher burden of symptoms among adult cancer survivors, but these symptoms were not related to survivors’ desire to quit smoking. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Continued smoking after a cancer diagnosis lowers survival rates, increases the likelihood of additional cancers, and decreases the effectiveness of cancer therapies. Understanding the relationship between tobacco use and the symptoms that patients experience may help clinicians tailor tobacco cessation interventions for individuals with cancer.

To study this relationship, Sarah Price, PhD, of the Wake Forest University School of Medicine, and her colleagues analyzed data on 1,409 adults who had a history of cancer and were participating in Wave 5 of the US FDA Population Assessment of Tobacco and Health (PATH) Study, which gathered detailed tobacco use information from a nationally representative sample of adults from December 2018 to November 2019.

Participants’ answers to questionnaires revealed that 14% and 3% of those who had been diagnosed with cancer currently smoked cigarettes or vaped, respectively. Current smoking was associated with greater fatigue, pain, emotional problems, and worse quality of life compared to participants who previously smoked and participants who never smoked. Current vaping was associated with greater fatigue, pain, and emotional problems, but not worse quality of life. These findings add to a growing body of evidence that continued smoking following a cancer diagnosis is a risk factor for worse outcomes.

There was no relationship between patients’ burden of symptoms and their interest in quitting smoking cigarettes, their likelihood of quitting, or their attempts to quit in the past year.

“Our finding that greater symptom burden was not associated with reduced interest in quitting smoking directly contradicts common assumptions that patients with cancer are resistant to tobacco cessation treatment because of their symptom burden. If smoking cessation is viewed as part of cancer symptom management, it may be more acceptable to both patients and the clinicians who treat them,” said Dr. Price. “Future research should also explore whether better management of cancer symptoms like pain, fatigue, or emotional problems helps survivors quit smoking.”


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