Tobacco use and cancer-related symptom burden: Analysis of the US Population Assessment of Tobacco and Health Study

Abstract

Background: Understanding the relationship between tobacco use and symptom burden may inform tobacco treatment interventions tailored to the needs of individuals with cancer.

Methods: The study included 1409 adult cancer survivors from Wave 5 of the US Food and Drug Administration Population Assessment of Tobacco and Health (PATH) Study. A multivariate analysis of variance controlling for age, sex, and race/ethnicity assessed the association of cigarette smoking and vaping on cancer-related symptom burden (fatigue, pain, emotional problems) and quality of life (QoL). Generalized linear mixed models controlling for the same factors were used to assess associations among symptom burden, QoL, and quit-smoking intentions, quit-smoking likelihood, and past 12-month smoking quit attempts.

Results: Weighted rates of current cigarette smoking and vaping were 14.21% and 2.88%, respectively. Current smoking was associated with greater fatigue (p < .0001; partial η ² = .02), pain (p < .0001; partial η ² = .08), emotional problems (p < .0001; partial η ² = .02), and worse QoL (p < .0001; partial η ² = .08). Current vaping was associated with greater fatigue (p = .001; partial η ² = .008), pain (p = .009; partial η ² = .005), and emotional problems (p = .04; partial η ² = .003), but not worse QoL (p = .17). Higher cancer symptom burden was not associated with reduced interest in quitting, likelihood of quitting, or odds of past year quit attempts (p > .05 for each).

Conclusions: Among adults with cancer, current smoking and vaping were associated with greater symptom burden. Survivors' interest in and intentions to quit smoking were not related to symptom burden. Future research should examine the role of tobacco cessation in improving symptom burden and QoL.

Keywords: cancer survivors; emotional distress; fatigue; pain; quality of life; tobacco use; vaping.

FIGURE 1

Symptom burden and quality of life by smoking status: least squared means with 95% CIs. ***p < .0001. (A) Average level of fatigue in the past 7 days ranged from 1 (none) to 5 (very severe). (B) Average level of pain in the past 7 days ranged from 0 (no pain) to 10 (worst pain imaginable). (C) Degree to which bothered by emotional problems in the past 7 days ranged from 1 (never) to 5 (very). (D) Self-rated QoL ranged from 1 (excellent) to 5 (poor), with higher scores indicating worse QoL. n.s. indicates not significant; QoL, quality of life.

FIGURE 2

Symptom burden and quality of life by vaping status: least squared means with 95% CIs. *p < .05; **p < .01. (A) Average level of fatigue in the past 7 days ranged from 1 (none) to 5 (very severe). (B) Average level of pain in the past 7 days ranged from 0 (no pain) to 10 (worst pain imaginable). (C) Degree to which bothered by emotional problems in the past 7 days ranged from 1 (never) to 5 (very). (D) Self-rated QoL ranged from 1 (excellent) to 5 (poor), with higher scores indicating worse QoL. n.s. indicates not significant; QoL, quality of life.