Association between tobacco use, pain expression, and coping strategies among patients with advanced cancer

Rony Dev, Yu Jung Kim, Akhila S Reddy, David Hui, Kimberson Cochien Tanco, Diane Liu, Minjeong Park, Janet Williams, Cindy Lynn Carmack, Eduardo Bruera

Research output: Contribution to journalArticle

Abstract

Background: The objective of the current study was to evaluate the association between tobacco use, symptom expression, and coping strategies in patients with advanced cancer. Methods: The authors prospectively enrolled patients with advanced cancer and collected data regarding patient demographics, cancer diagnosis, morphine equivalent daily dose, cigarette smoking status using the Behavioral Risk Factor Surveillance System, symptom expression as measured by the Edmonton Symptom Assessment System, the Cut down/Annoyed/Guilty/Eye opener alcoholism questionnaire, the Screener and Opioid Assessment for Patients with Pain–short form survey, and the Brief COPE Questionnaire. Results: Among 399 patients, 195 (49%) were never-smokers, 158 (40%) were former smokers, and 46 (11%) were current smokers. The most common malignancies were gastrointestinal (21%) and breast (19%). Current smokers demonstrated significantly higher pain scores at the time of consultation compared with former or never-smokers (mean 6.4 vs 5.9 vs 5.1, respectively; P =.015), demonstrated increased morphine equivalent daily dose (median 90 mg/day vs 60 mg/day vs 50 mg/day, respectively; P =.002), were more likely to screen as positive on the Cut down/Annoyed/Guilty/Eye opener questionnaire (33% vs 24% vs 8.7%, respectively; P <.0001) and were more likely to screen as positive (≥4) on the Screener and Opioid Assessment for Patients with Pain–short form survey (74% vs 13% vs 9.3%, respectively; P <.0001). Compared with former and never-smokers, current smokers were significantly more likely to cope maladaptively with substance use (P =.02), denial (P =.007), and self-blame (P <.0001). Conclusions: Among patients with advanced cancer, current and former smokers appear to be significantly more likely to have higher pain expression and thus require higher opioid doses, and to have more risk factors for using opioids in a nonprescribed manner. The results of the current study highlight the need to provide closer monitoring and increased psychosocial support for patients with cancer who smoke while receiving chronic opioid therapy.

LanguageEnglish (US)
Pages153-160
Number of pages8
JournalCancer
Volume125
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Tobacco Use
Pain
Opioid Analgesics
Neoplasms
Morphine
Behavioral Risk Factor Surveillance System
Symptom Assessment
Substance P
Smoke
Alcoholism
Breast
Referral and Consultation
Smoking
Demography
Surveys and Questionnaires

Keywords

  • advanced cancer
  • cancer pain
  • chemical coping
  • nonmedical drug use
  • tobacco use

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Association between tobacco use, pain expression, and coping strategies among patients with advanced cancer. / Dev, Rony; Kim, Yu Jung; Reddy, Akhila S; Hui, David; Tanco, Kimberson Cochien; Liu, Diane; Park, Minjeong; Williams, Janet; Carmack, Cindy Lynn; Bruera, Eduardo.

In: Cancer, Vol. 125, No. 1, 01.01.2019, p. 153-160.

Research output: Contribution to journalArticle

@article{46b8aeb3ce5342e3b066266243b2837a,
title = "Association between tobacco use, pain expression, and coping strategies among patients with advanced cancer",
abstract = "Background: The objective of the current study was to evaluate the association between tobacco use, symptom expression, and coping strategies in patients with advanced cancer. Methods: The authors prospectively enrolled patients with advanced cancer and collected data regarding patient demographics, cancer diagnosis, morphine equivalent daily dose, cigarette smoking status using the Behavioral Risk Factor Surveillance System, symptom expression as measured by the Edmonton Symptom Assessment System, the Cut down/Annoyed/Guilty/Eye opener alcoholism questionnaire, the Screener and Opioid Assessment for Patients with Pain–short form survey, and the Brief COPE Questionnaire. Results: Among 399 patients, 195 (49{\%}) were never-smokers, 158 (40{\%}) were former smokers, and 46 (11{\%}) were current smokers. The most common malignancies were gastrointestinal (21{\%}) and breast (19{\%}). Current smokers demonstrated significantly higher pain scores at the time of consultation compared with former or never-smokers (mean 6.4 vs 5.9 vs 5.1, respectively; P =.015), demonstrated increased morphine equivalent daily dose (median 90 mg/day vs 60 mg/day vs 50 mg/day, respectively; P =.002), were more likely to screen as positive on the Cut down/Annoyed/Guilty/Eye opener questionnaire (33{\%} vs 24{\%} vs 8.7{\%}, respectively; P <.0001) and were more likely to screen as positive (≥4) on the Screener and Opioid Assessment for Patients with Pain–short form survey (74{\%} vs 13{\%} vs 9.3{\%}, respectively; P <.0001). Compared with former and never-smokers, current smokers were significantly more likely to cope maladaptively with substance use (P =.02), denial (P =.007), and self-blame (P <.0001). Conclusions: Among patients with advanced cancer, current and former smokers appear to be significantly more likely to have higher pain expression and thus require higher opioid doses, and to have more risk factors for using opioids in a nonprescribed manner. The results of the current study highlight the need to provide closer monitoring and increased psychosocial support for patients with cancer who smoke while receiving chronic opioid therapy.",
keywords = "advanced cancer, cancer pain, chemical coping, nonmedical drug use, tobacco use",
author = "Rony Dev and Kim, {Yu Jung} and Reddy, {Akhila S} and David Hui and Tanco, {Kimberson Cochien} and Diane Liu and Minjeong Park and Janet Williams and Carmack, {Cindy Lynn} and Eduardo Bruera",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/cncr.31783",
language = "English (US)",
volume = "125",
pages = "153--160",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "1",

}

TY - JOUR

T1 - Association between tobacco use, pain expression, and coping strategies among patients with advanced cancer

AU - Dev, Rony

AU - Kim, Yu Jung

AU - Reddy, Akhila S

AU - Hui, David

AU - Tanco, Kimberson Cochien

AU - Liu, Diane

AU - Park, Minjeong

AU - Williams, Janet

AU - Carmack, Cindy Lynn

AU - Bruera, Eduardo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The objective of the current study was to evaluate the association between tobacco use, symptom expression, and coping strategies in patients with advanced cancer. Methods: The authors prospectively enrolled patients with advanced cancer and collected data regarding patient demographics, cancer diagnosis, morphine equivalent daily dose, cigarette smoking status using the Behavioral Risk Factor Surveillance System, symptom expression as measured by the Edmonton Symptom Assessment System, the Cut down/Annoyed/Guilty/Eye opener alcoholism questionnaire, the Screener and Opioid Assessment for Patients with Pain–short form survey, and the Brief COPE Questionnaire. Results: Among 399 patients, 195 (49%) were never-smokers, 158 (40%) were former smokers, and 46 (11%) were current smokers. The most common malignancies were gastrointestinal (21%) and breast (19%). Current smokers demonstrated significantly higher pain scores at the time of consultation compared with former or never-smokers (mean 6.4 vs 5.9 vs 5.1, respectively; P =.015), demonstrated increased morphine equivalent daily dose (median 90 mg/day vs 60 mg/day vs 50 mg/day, respectively; P =.002), were more likely to screen as positive on the Cut down/Annoyed/Guilty/Eye opener questionnaire (33% vs 24% vs 8.7%, respectively; P <.0001) and were more likely to screen as positive (≥4) on the Screener and Opioid Assessment for Patients with Pain–short form survey (74% vs 13% vs 9.3%, respectively; P <.0001). Compared with former and never-smokers, current smokers were significantly more likely to cope maladaptively with substance use (P =.02), denial (P =.007), and self-blame (P <.0001). Conclusions: Among patients with advanced cancer, current and former smokers appear to be significantly more likely to have higher pain expression and thus require higher opioid doses, and to have more risk factors for using opioids in a nonprescribed manner. The results of the current study highlight the need to provide closer monitoring and increased psychosocial support for patients with cancer who smoke while receiving chronic opioid therapy.

AB - Background: The objective of the current study was to evaluate the association between tobacco use, symptom expression, and coping strategies in patients with advanced cancer. Methods: The authors prospectively enrolled patients with advanced cancer and collected data regarding patient demographics, cancer diagnosis, morphine equivalent daily dose, cigarette smoking status using the Behavioral Risk Factor Surveillance System, symptom expression as measured by the Edmonton Symptom Assessment System, the Cut down/Annoyed/Guilty/Eye opener alcoholism questionnaire, the Screener and Opioid Assessment for Patients with Pain–short form survey, and the Brief COPE Questionnaire. Results: Among 399 patients, 195 (49%) were never-smokers, 158 (40%) were former smokers, and 46 (11%) were current smokers. The most common malignancies were gastrointestinal (21%) and breast (19%). Current smokers demonstrated significantly higher pain scores at the time of consultation compared with former or never-smokers (mean 6.4 vs 5.9 vs 5.1, respectively; P =.015), demonstrated increased morphine equivalent daily dose (median 90 mg/day vs 60 mg/day vs 50 mg/day, respectively; P =.002), were more likely to screen as positive on the Cut down/Annoyed/Guilty/Eye opener questionnaire (33% vs 24% vs 8.7%, respectively; P <.0001) and were more likely to screen as positive (≥4) on the Screener and Opioid Assessment for Patients with Pain–short form survey (74% vs 13% vs 9.3%, respectively; P <.0001). Compared with former and never-smokers, current smokers were significantly more likely to cope maladaptively with substance use (P =.02), denial (P =.007), and self-blame (P <.0001). Conclusions: Among patients with advanced cancer, current and former smokers appear to be significantly more likely to have higher pain expression and thus require higher opioid doses, and to have more risk factors for using opioids in a nonprescribed manner. The results of the current study highlight the need to provide closer monitoring and increased psychosocial support for patients with cancer who smoke while receiving chronic opioid therapy.

KW - advanced cancer

KW - cancer pain

KW - chemical coping

KW - nonmedical drug use

KW - tobacco use

UR - http://www.scopus.com/inward/record.url?scp=85055585503&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055585503&partnerID=8YFLogxK

U2 - 10.1002/cncr.31783

DO - 10.1002/cncr.31783

M3 - Article

VL - 125

SP - 153

EP - 160

JO - Cancer

T2 - Cancer

JF - Cancer

SN - 0008-543X

IS - 1

ER -