Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Cancer. 2019 Jan 1;125(1):153-160. doi: 10.1002/cncr.31783. Epub 2018 Oct 23.
The objective of the current study was to evaluate the association between tobacco use, symptom expression, and coping strategies in patients with advanced cancer.
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.
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).
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.
本研究的目的是评估晚期癌症患者中吸烟、症状表现和应对策略之间的关联。
作者前瞻性地招募了晚期癌症患者，并收集了患者人口统计学、癌症诊断、吗啡等效日剂量、使用行为风险因素监测系统评估的吸烟状况、 Edmonton 症状评估系统评估的症状表现、Cut down/Annoyed/Guilty/Eye opener 酒精问卷、Screener 和 Opioid Assessment for Patients with Pain-short form 调查以及 Brief COPE 问卷的数据。
在 399 名患者中，195 名（49%）为从不吸烟者，158 名（40%）为前吸烟者，46 名（11%）为现吸烟者。最常见的恶性肿瘤是胃肠道（21%）和乳腺（19%）。与前吸烟者或从不吸烟者相比，现吸烟者在就诊时疼痛评分明显更高（分别为 6.4 分、5.9 分和 5.1 分；P = .015），吗啡等效日剂量更高（中位数分别为 90 mg/天、60 mg/天和 50 mg/天；P = .002），更有可能在 Cut down/Annoyed/Guilty/Eye opener 问卷上筛查为阳性（分别为 33%、24%和 8.7%；P < .0001），更有可能在 Screener 和 Opioid Assessment for Patients with Pain-short form 调查上筛查为阳性（≥4）（分别为 74%、13%和 9.3%；P < .0001）。与前吸烟者和从不吸烟者相比，现吸烟者更有可能以不适应的方式应对物质使用（P = .02）、否认（P = .007）和自责（P < .0001）。
在晚期癌症患者中，现吸烟者和前吸烟者似乎更有可能出现更高的疼痛表现，因此需要更高的阿片类药物剂量，并且更有可能存在非处方使用阿片类药物的风险因素。本研究的结果强调了需要对接受慢性阿片类药物治疗的同时吸烟的癌症患者进行更密切的监测和增加心理社会支持。
