title: Association Between Tobacco Use, Symptom Expression, and Alcohol and Illicit Drug Use in Advanced Cancer Patients.
abstract: BACKGROUND
  Limited knowledge exists examining the association between smoking status, symptom expression, and alcohol or illicit drug use.
  
  
  OBJECTIVE
  The goal of this study was to clarify these associations in patients with advanced cancer.
  
  
  METHODS
  We retrospectively reviewed 560 charts and identified 300 consecutive advanced cancer patients who completed a comprehensive smoking questionnaire. Data including the Edmonton Symptom Assessment System, Cut down/Annoyed/Guilty/Eye opener (CAGE) alcoholism screening questionnaire, illicit drug use history, and daily opioid requirements-morphine equivalent daily dose-were collected.
  
  
  RESULTS
  Among 300 patients, 119 (40%) were never smokers, 148 (49%) former smokers, and 33 (11%) current smokers. The most common malignancies were gastrointestinal (28%) and lung (20%). Current smokers were more likely to be single (P < 0.01) and significantly younger than former smokers (P < 0.001) but did not differ in age from never smokers. Never smokers were more likely to be female (P < 0.001). Current smokers reported significantly higher pain expression than former and never smokers (median 7 vs. 5.5 vs. 5, respectively, P = 0.02), higher CAGE positivity (42% vs. 21% vs. 3%, P < 0.001) and were more likely to have a history of illicit drug use (33% vs. 16% vs. 3%, P < 0.001). The morphine equivalent daily dose was not significantly different according to smoking status.
  
  
  CONCLUSIONS
  In advanced cancer, patients who were former or current smokers were significantly more likely to have a history of CAGE positivity and illicit drug use compared with never smokers. Current smokers expressed significantly higher pain. A smoking history may be a marker of an increased risk of opioid misuse.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Yu Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: rdev@mdanderson.org.
authors.forename: Rony
authors.initials: R
authors.lastname: Dev
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Akhila
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Kimberson
authors.initials: K
authors.lastname: Tanco
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Minjeong
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Williams
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D000428:Alcohol Drinking / Q000503:physiopathology; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000072716:Cancer Pain / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000503:physiopathology; D064424:Tobacco Use / Q000503:physiopathology
chemical_list: D000701:Analgesics, Opioid; D013287:Illicit Drugs
keywords: Advanced cancer; alcoholism; cancer pain; chemical coping; opioid; symptom; tobacco use