title: The effect of cigarette smoking on cancer treatment-related side effects.
abstract: BACKGROUND
  Cigarette smoking has long been implicated in cancer development and survival. However, few studies have investigated the impact of smoking on symptom burden in cancer survivors during treatment and at survivorship stage. This study examines the influence of cigarette smoking on side effects among 947 cancer patients during and 6 months following treatment.
  
  
  METHODS
  Patients diagnosed with cancer and scheduled to receive chemotherapy and/or radiation therapy reported on current smoking status (yes, no) and total symptom burden [the sum of 12 common symptoms (fatigue, hair loss, memory, nausea, depression, sleep, pain, concentration, hot flashes, weight loss, skin problems, and dyspnea) scored on an 11-point scale ranging from 0 = "not present" to 10 = "as bad as you can imagine"] during treatment and at 6-month follow-up. The adjusted mean total symptom burden by smoking status was determined by analysis of covariance controlling for age, gender, race, education, occupation, treatment, cancer site, and Karnofsky performance score.
  
  
  RESULTS
  During treatment, smokers (S) had a significantly higher total symptom burden than nonsmokers (NS) (S = 46.3 vs. NS = 41.2; p < 0.05). At 6-month follow-up, smokers continued to report a higher total symptom burden than nonsmokers (S = 27.7 vs. NS = 21.9; p < 0.05). Participants who quit smoking before treatment levels had a total symptom burden similar to nonsmokers.
  
  
  CONCLUSIONS
  Smoking was associated with an increased symptom burden during and following treatments for cancer. Targeted cessation efforts for smokers to decrease symptom burden may limit the likelihood of treatment interruptions and increase quality of life following treatment.
authors.affiliation: Department of Radiation Oncology, University of Rochester, Rochester, New York 14642, USA. luke_peppone@urmc.rochester.edu
authors.forename: Luke J
authors.initials: LJ
authors.lastname: Peppone
authors.forename: Karen M
authors.initials: KM
authors.lastname: Mustian
authors.forename: Gary R
authors.initials: GR
authors.lastname: Morrow
authors.forename: Ann M
authors.initials: AM
authors.lastname: Dozier
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Ossip
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Janelsins
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Sprod
authors.forename: Scott
authors.initials: S
authors.lastname: McIntosh
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents