Smoking worsens symptoms during cancer remission

3 minute read

Vaping and cigarette smoking was linked to higher rates of pain, fatigue and emotional distress.

Adults in cancer remission who smoke or vape experience more intense pain, fatigue and emotional distress than non-smokers, according to a large US study.

Despite this, higher symptom severity didn’t seem to increase the likelihood that participants would quit, according to the paper in Cancer.

Researchers said this was the first study to include vaping in investigating the relationship between smoking and post-cancer symptoms, and one of the few to analyse patient attitude towards quitting.

They found that of the 1400 participants in remission and more than one year out from their diagnosis, 14% reported currently smoking and 3% reported current vaping.

Both cigarette and e-cigarette smokers had more severe symptoms of fatigue, depressive symptoms, anxiety, irritability and pain, while worse quality of life was only found in the cigarette smoking group.

Former smokers exhibited comparable levels of fatigue and emotional issues to those who had never smoked, but they reported higher levels of pain.

Interestingly, higher cancer symptom burden was not associated with reduced interest in quitting, likelihood of quitting, or odds of past year quit attempts.

“These findings directly contradict common clinical assumptions that patients are resistant to tobacco treatment or that treating tobacco use will induce significant discomfort”, the authors wrote.

The authors noted that quitting smoking had not been treated as a priority for post-remission symptoms management. They pointed to studies suggesting oncology care providers, particularly in palliative care, were less likely to view tobacco smoking as a hindrance to their health and encourage them to quit.

“It is critically important that oncology providers assess tobacco use, offer tobacco-cessation support, and take ownership of the delivery of tobacco treatment to oncology patients”, the authors added.

The data analysis did not account for cancer stage/severity or provide extensive information about the patients’ cancer history, thus limiting the ability to establish associations between smoking individuals and their risk of developing specific types of cancer (such as lung cancer) in the study.

Moreover, the study’s small sample size of e-cigarette users and its cross-sectional design pose limitations in determining whether the exacerbated symptoms were directly attributed to tobacco use or vaping. It is worth noting that 64.16% of tobacco users also reported cigarette smoking, further complicating the evaluation of the specific effects of vaping alone.

“Future research on cigarette and e-cigarette use among cancer populations should aim to have fully representative samples, especially because we observed that current-smoking status differed by key demographics (age group, sex, income and education), indicating that continued smoking postdiagnosis may be both a product of and contributor to health disparities.”

Cancer 2023, online 22 May

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