College of Nursing, Aichi Medical University, Nagakute, Aichi, Japan.
Institute for Occupational Health Science, Aichi Medical University, Nagakute, Aichi, Japan.
PLoS One. 2022 Aug 9;17(8):e0272779. doi: 10.1371/journal.pone.0272779. eCollection 2022.
Whether abstinence from smoking among cancer patients reduces cancer pain is still unclear. Opioids can act as a surrogate index for evaluating the incidence of severe cancer pain in countries where opioid abuse is infrequent. This study aimed to investigate whether changed smoking behavior after cancer diagnosis influences the incidence of severe cancer pain as determined by strong opioid use.
Using a large Japanese insurance claims database (n = 4,797,329), we selected 794,702 insured employees whose annual health checkup data could be confirmed ≥6 times between January 2009 and December 2018. We selected 591 study subjects from 3,256 employees who were diagnosed with cancer pain and had health checkup data at the year of cancer pain diagnosis.
A significantly greater proportion of patients who continued smoking after cancer diagnosis ("current smoker", n = 133) received strong opioids (36.8%) compared with patients who had never smoked or had stopped before cancer diagnosis ("non-smoker", n = 383, 20.6%; p<0.05) but also compared with patients who had quit smoking after cancer diagnosis ("abstainer:", n = 75, 24.0%; p<0.05). In multivariable Cox proportional hazards regression analysis, abstainers had a significantly lower risk of receiving strong opioids than current smokers (hazard ratio: 0.57, 95% CI: 0.328 to 0.997). These findings were consistent across multiple sensitivity analyses.
Our study demonstrated that patients who quit smoking after cancer diagnosis have a lower risk of severe cancer pain. This information adds clinical incentives for improving quality of life among those who smoked at the time of cancer diagnosis.
癌症患者戒烟是否会减轻癌症疼痛尚不清楚。在阿片类药物滥用不常见的国家，阿片类药物可以作为评估严重癌症疼痛发生率的替代指标。本研究旨在调查癌症诊断后吸烟行为的改变是否会影响强阿片类药物使用所确定的严重癌症疼痛的发生率。
我们使用一个大型日本保险索赔数据库（n=4797329），选择了 794702 名参保员工，他们在 2009 年 1 月至 2018 年 12 月期间每年的健康检查数据可确认≥6 次。我们从 3256 名被诊断患有癌症疼痛且在癌症疼痛诊断年度有健康检查数据的员工中选择了 591 名研究对象。
与从未吸烟或在癌症诊断前已戒烟的患者（非吸烟者，n=383，20.6%；p<0.05）相比，癌症诊断后继续吸烟的患者（“当前吸烟者”，n=133）更有可能接受强阿片类药物（36.8%），与癌症诊断后已戒烟的患者（“戒烟者”，n=75，24.0%；p<0.05）相比也更多。多变量 Cox 比例风险回归分析显示，与当前吸烟者相比，戒烟者接受强阿片类药物的风险显著降低（风险比：0.57，95%CI：0.328 至 0.997）。这些发现在多项敏感性分析中均一致。
我们的研究表明，癌症诊断后戒烟的患者严重癌症疼痛的风险较低。这一信息为改善那些在癌症诊断时吸烟的人的生活质量提供了临床激励。
