Smoking status and pain level among head and neck cancer patients

Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort

PURPOSE

Reports suggest pain is common in head and neck cancer (HNC). However, past studies are limited by small sample sizes and design and measurement heterogeneity. Using data from the Head and Neck 5000 longitudinal cohort, we investigated pain over a year post-diagnosis. We assessed: temporal trends; compared pain across HNC treatments, stages, sites and by HPV status; and identified subgroups of patients at increased risk of pain.

METHODS

Sociodemographic and clinical data and patient-reported pain (measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline (pre-treatment), 4- and 12- months. Using mixed effects multivariable regression, we investigated time trends and identified associations between (i) clinically-important general pain and (ii) HN-specific pain and clinical, socio-economic, and demographic variables.

RESULTS

2,870 patients were included. At baseline, 40.9% had clinically-important general pain, rising to 47.6% at 4-months and declining to 35.5% at 12-months. HN-specific pain followed a similar pattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55); 12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels were increased in: younger patients, smokers, and those with depression and comorbidities at baseline, and more advanced, oral cavity and HPV negative cancers.

CONCLUSIONS

There is high prevalence of general pain in people living with HNC. We identified subgroups more often reporting general and HN-specific pain towards whom interventions could be targeted.

IMPLICATIONS FOR CANCER SURVIVORS

Greater emphasis should be placed on identifying and treating pain in HNC. Systematic pain screening could help identify those who could benefit from an early pain management plan.

Examination of Predictors of Pain at 12 Months Postdiagnosis in Head and Neck Cancer Survivors

OBJECTIVE

Pain following the completion of treatment is important but has received less attention in the head and neck cancer (HNC) literature. The present study sought to examine the prevalence and predictors of pain measured 12 months postdiagnosis and its impact on HNC-specific health-related quality of life (HRQOL) in 1038 HNC survivors.

STUDY DESIGN

Prospective observational study.

SETTING

Single-institution tertiary care center.

METHODS

Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing the worst pain possible. Self-reported depressive symptomatology was measured using the Beck Depression Inventory and self-reported problem alcohol use was measured by the Short Michigan Alcoholism Screening Test. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI).

RESULTS

Hierarchical multivariable linear regression analyses indicated that in addition to pain at 3 months postdiagnosis (β = .145, t = 3.18, sr2  = .019, p = .002), both depressive symptomatology (β = .110, t = 2.49, sr2  = .011, p = .015) and problem alcohol use (β = .092, t = 2.07, sr2  = .008, p = .039) were significant predictors of pain at 12 months postdiagnosis. Subgroup analyses suggest that across all 4 HNCI domains, those in the moderate and severe pain groups at 12 months postdiagnosis failed to reach 70 which is indicative of high functioning.

CONCLUSION

Pain in patients with HNC is a considerable issue at 12 months postdiagnosis, deserving further attention. Behavioral factors such as depression and problem alcohol use may be associated with pain and require systematic screening over time to identify and treat issues that impact optimal long-term recovery from HNC, including disease-specific HRQOL.

Supportive Care Needs Among Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Nested Cross-Sectional Qualitative Analysis

OBJECTIVES

To qualitatively characterize pretreatment head and neck cancer (HNC) patients' supportive care (SC) needs, attitudes toward SC, and barriers to SC utilization.

MATERIALS AND METHODS

A prospective, nested, bi-institutional, cross-sectional pilot study design was employed. Participants were sub-selected from a representative sample of 50 patients newly diagnosed with mucosal or salivary gland HNC or sarcoma of the head and neck. Eligibility criteria included reporting ≥2 unmet needs (according to the Supportive Care Needs Survey-Short Form 34) or clinically-significant distress (National Comprehensive Cancer Network Distress Thermometer score ≥4). Semi-structured interviews were performed prior to initiation of oncologic treatment. Audio-recorded interviews were transcribed and thematically analyzed using NVivo 12.0 (QSR Australia). Thematic findings and representative quotes were interpreted by the entire research team.

RESULTS

Twenty-seven patients were interviewed. One-third were treated at the county safety-net hospital and the remainder were treated at the university health system. An equal proportion of patients presented with oral cavity, oropharyngeal, and laryngeal or other tumors. Two significant findings were identified on semi-structured interviews. First, patients did not perceive the relevance of SC prior to treatment. Second, anxiety surrounding the HNC diagnosis and impending treatment dominated in the pretreatment phase.

CONCLUSION

Improved HNC patient education about the relevance and importance of SC in the pretreatment setting is needed. Integration of social work or psychological services in HNC clinics is warranted to address patients' cancer-related worry-a discrete, dominant pretreatment SC need.

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

PURPOSE

While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC.

METHODS

We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models.

RESULTS

Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86).

CONCLUSION

We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.

Consensus statement on smoking cessation in patients with pain

Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.

The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic review

PURPOSE

Human papillomavirus (HPV) is now the primary cause of oropharyngeal head and neck cancer (OPC) worldwide; yet limited research has examined the effect of HPV-positive status (OPC+) on nutrition outcomes. This study aims to determine the impact of HPV status on nutritional outcomes for adult patients with OPC undergoing any treatment modality.

METHODS

A systematic literature review was conducted up to and including July 2021 of PubMed, Embase, CENTRAL, CINAHL, and Web of Science to identify studies conducted in adults (>18 years) with known OPC reporting on any outcome(s) related to nutrition, according to HPV status (OPC+ versus OPC-). Bias was assessed using QUIPS tool, with certainty of evidence assessed using GRADE system.

RESULTS

Six studies (total n = 635) all at moderate-high risk of bias were included. Three studies reported on weight change (n = 255), three feeding tube dependency (n = 380), three feeding tube timing of placement (prophylactic or reactive) and/or utilisation (n = 255), two nutritional (energy and/or protein) intake (n = 230), and one nutritional status (n = 83). Patients with OPC+ may experience greater weight loss, may have higher utilisation of reactive feeding tubes (both GRADE low certainty, downgraded due to serious bias and imprecision), and may have lower feeding tube dependency rates (GRADE low certainty, downgraded due to serious bias and inconsistency) versus OPC- . It is uncertain whether nutritional intake and nutritional status differed between populations (GRADE very low certainty, downgraded due to serious bias and very serious imprecision).

CONCLUSION

Further, high-quality research is needed to understand optimal nutritional care practices for patients with OPC + to achieve positive health outcomes into survivorship.

Smoking cessation after cancer diagnosis reduces the risk of severe cancer pain: A longitudinal cohort study

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Head and neck cancer survivors' pain in France: the VICAN study

PURPOSE

Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors.

METHODS

Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national "vie après le cancer" (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients' living conditions, socioeconomic characteristics, and medical data were collected.

RESULTS

Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48-5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27-4.88), education (at least a high school's degree) (OR= 0.33, CI= 0.13-0.9), and decreased physical activity (OR= 2.20, CI= 1.24-3.9).

CONCLUSIONS

Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain.

IMPLICATIONS FOR CANCER SURVIVORS

Pain frequency and its impact on patients' lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals.

CLINICAL TRIAL REGISTRATION

This is not a clinical trial. ISP number: INSERM C11-63.

Risk Factors and Prevention Strategies for Postoperative Opioid Abuse

Worldwide, 80% of patients who undergo surgery receive opioid analgesics as the fundamental agent for pain relief. However, the irrational use of opioids leads to excessive drug dependence and drug abuse, resulting in an increased mortality rate and huge economic loss. The crisis of opioid overuse remains a great challenge. In this review, we summarize several key factors in opioid abuse, including race, region, income, genetic factors, age and gender, smoking and alcohol abuse, history of chronic pain and analgesic drug abuse, surgery, neuropsychiatric illness, depression and antidepressant use, human factors, national policies, hospital regulations, and health insurance under treatment of pain. Furthermore, we present several prevention strategies, such as perioperative measures, opioid substitutes, treatment of the primary illness, emotional regulation, use of opioid antagonists, efforts of the state, hospitals, doctors and pharmacy benefit managers, gene therapy, and vaccines. Greater understanding and better assessment are required of the risks associated with opioid abuse to ensure the safety and analgesic effects of pain treatment after surgery.

Does smoking abstinence predict cancer patients' quality of life over time?

OBJECTIVE

Smoking cessation improves quality of life (QOL) in the general population. However, there is limited information on the role of smoking status on QOL among cancer patients. Moreover, previous studies tended to analyze smoking status dichotomously and at a single point in time, potentially reducing the strength of the relation between smoking cessation and QOL. This study examined the association of smoking abstinence and QOL over time, including depression, pain, and fatigue in patients with a wide variety of cancers.

METHODS

Participants were 332 cancer patients (eg, gynecologic, breast, thoracic, head and neck, and genitourinary) who had been abstinent for at least 24 hours. Days abstinent and QOL were assessed at baseline and 2, 6, and 12 months later. Latent growth curve models examined if days abstinent was associated with QOL at each assessment. Baseline demographics (eg, sex and income) and smoking history variables (eg, nicotine dependence) were used as time-invariant covariates.

RESULTS

The final model for each QOL component had good-to-excellent fit. More days abstinent was associated with lower depression at all follow-ups and with lower fatigue at 12 months but was not associated with pain.

CONCLUSIONS

QOL was better among patients who quit smoking for longer periods. Findings suggest different timelines, with smoking abstinence most immediately associated with lower depression, followed by lower fatigue. Although pain decreased over time, it was not associated with length of smoking abstinence. Results reinforce the relationship between sustained smoking cessation and QOL, which should be communicated to patients.

Effect of preoperative smoking cessation on postoperative pain outcomes in elderly patients with high nicotine dependence

OBJECTIVE

To investigate the effect of smoking cessation before surgery on postoperative pain and analgesic consumption after thoracoscopic radical resection of lung cancer in elderly patients with high nicotine dependence.

METHODS

A total of 107 male patients, ages 60 to 70 years, undergoing elective thoracoscopic radical lung cancer surgery from July 2017 to July 2018 were enrolled into 3 groups: group A (highly nicotine-dependent and discontinued smoking <3 weeks before surgery, n = 36), group B (highly nicotine-dependent and discontinued smoking >3 weeks before surgery, n = 38), and group C (nonsmokers, n = 33). Postoperative sufentanil consumption, visual analog scale (VAS) pain scores at rest and during cough, rescue analgesia, opioid-related adverse events, and patient satisfaction were assessed from 0 to 48 h postoperatively.

RESULTS

Patient characteristics were comparable among the 3 groups. Sufentanil consumption and VAS pain scores from postoperative 0 to 48 h were significantly higher in groups A and B than in group C. In addition, group B had lower sufentanil consumption and pain scores than group A. No differences in the need for rescue analgesia, patient satisfaction, or occurrence of postoperative adverse events, including nausea, vomiting, respiratory depression, and oversedation, were observed among the 3 groups.

CONCLUSION

Compared with nonsmokers, highly nicotine-dependent male patients who were deprived of cigarettes experienced more severe pain and required treatment with more sufentanil after thoracoscopic radical lung cancer surgery. Moreover, preoperative smoking cessation at least 3 weeks before surgery led to better postoperative pain outcomes than smoking cessation within 3 weeks of surgery.

Heightened olfactory dysfunction and oral irritation among chronic smokers and heightened propylthiouracil (PROP) bitterness among menthol smokers

Chronic cigarette smoking may influence chemosensory function, which in turn, may affect cigarette usage. Because menthol in cigarettes can attenuate nicotine bitterness, choice of menthol/nonmenthol cigarettes may be influenced by ability to perceive bitterness. We examined chemosensory function of chronic smokers, hypothesizing they would show altered function in comparison to non-smokers and by menthol cigarette preference. In laboratory-based measures, chronic smokers (N = 135; 84 menthol smokers) self-reported their chemosensory function and participated in smell (identification task with perceived intensity) and taste (quinine and NaCl intensity on tongue-tip and whole mouth) testing. A taste genetics probe (propylthiouracil (PROP) bitterness) also was assessed. Self-reported and measured chemosensory function were compared with nationally-representative 2013-2014 National Health and Nutrition Examination Survey (NHANES) data generated with similar measures. The taste measures also were compared between smokers and age- and sex-matched non-smokers from a laboratory database. Frequencies of self-reported smell and taste alterations among smokers exceeded NHANES prevalence estimates for non-smokers. The rate of measured smell dysfunction also exceeded NHANES prevalence for hyposmia. Compared to non-smokers, smokers reported elevated tongue-tip and whole mouth intensities from 1 M NaCl, with no significant differences in whole mouth quinine or 0.32 M NaCl. Inconsistent with previous hypotheses, smokers were not more likely to report depressed PROP bitterness than non-smokers. However, as expected, menthol smokers reported greater PROP bitterness than non-menthol smokers. In conclusion, chemosensory alterations were more frequent among chronic smokers, including hyposmia and heightened intensity from NaCl at an oral-irritant concentration. PROP supertasters were most likely to prefer mentholated cigarettes.

Association between tobacco use, pain expression, and coping strategies among patients with advanced cancer

BACKGROUND

The objective of the current study was to evaluate the association between tobacco use, symptom expression, and coping strategies in patients with advanced cancer.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Psychosocial Issues in Patients with Head and Neck Cancer: an Updated Review with a Focus on Clinical Interventions

PURPOSE OF REVIEW

There are frequent and diverse psychosocial issues that afflict patients with head and neck cancer (HNC) across the illness trajectory, prompting a focus on clinical interventions to prevent and mitigate psychosocial distress. We sought to characterize current understanding on the cause, effects, and interplay of various psychosocial factors in HNC and summarize updated, evidence-based interventions.

RECENT FINDINGS

The psychosocial experience of patients with HNC is characterized by a disproportionately high incidence of depression, suicide, continued substance dependence/abuse, and distress related to relationship conflict, social isolation, disfigurement, and damage to self-image. As we move towards a more thorough understanding and greater appreciation of the relationship between HNC and patient quality of life (QoL), future research focuses on implementation of effective, accessible clinical interventions to alleviate psychosocial distress in this population.

Smoking status and symptom burden in surgical head and neck cancer patients

OBJECTIVES/HYPOTHESIS

Head and neck squamous cell carcinoma (HNSCC) patients who smoke are at risk for poor treatment outcomes. This study evaluated symptom burden and clinical, sociodemographic, and psychosocial factors associated with smoking in surgical patients to identify potential targets for supportive care services.

STUDY DESIGN

Cross-sectional survey.

METHODS

Individuals with HNSCC of the oral cavity, larynx, or pharynx were recruited from two cancer centers and completed questionnaires assessing smoking status (never, former, current/recent), patient characteristics, and symptoms before surgery.

RESULTS

Of the 103 patients enrolled, 73% were male, 52% were stage IV, 41% reported current/recent smoking, and 37% reported former smoking. Current/recent smokers were less likely than former smokers to have adequate finances (53% vs. 89%, P = .001) and be married/partnered (55% vs. 79%, P = .03). Current/recent smokers were also more likely than both former and never smokers to be unemployed (49% vs. 40% and 13%, respectively, all P = .02) and lack health insurance (17% vs. 5% and 13%, respectively, all P ≤.04). Fatalistic beliefs (P = .03) and lower religiosity (P =.04) were more common in current/recent than never smokers. In models adjusted for sociodemographic/clinical factors, current/recent smokers reported more problems than former and never smokers with swallowing, speech, and cough (P ≤.04). Current/recent smokers also reported more problems than never smokers with social contact, feeling ill, and weight loss (P ≤ .02).

CONCLUSIONS

HNSCC patients reporting current/recent smoking before surgery have high-risk clinical and sociodemographic features that may predispose them to poor postoperative outcomes. Unique symptoms in HNSCC smokers may be useful targets for patient-centered clinical monitoring and intervention.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:127-133, 2017.

Effect of smoking status and nicotine dependence on pain intensity and outcome of treatment in Indian patients with temporomandibular disorders: A longitudinal cohort study

PURPOSE

Evidence regarding the association of smoking with various forms of chronic musculoskeletal pain is vast, but that with temporomandibular disorders (TMD) is scarce.

AIMS

The aims of this study are to evaluate the effect of smoking status (SS) and nicotine dependence (ND) on TMD pain intensity and treatment outcome in an Indian population with TMD.

SUBJECTS AND METHODS

Nine hundred and sixty-two patients with TMD were selected for this longitudinal cohort study. Lifetime SS was evaluated and patients were classified as current smokers (YS), former smokers (FS), or nonsmokers (NS). The Fagerstrom test was used to evaluate the ND of YS. Pain intensity was evaluated using visual analog scale scores. Six months posttreatment, the pain intensity was again recorded. The effect of treatment was evaluated using a global transition outcome measure and categorized as treatment success or failure. A minimum 30% reduction in pain was used as a criterion for categorizing patients as those who had gotten "better." Data obtained from the study were compared using Chi-square tests, paired samples t-tests, and one-way ANOVA tests. The criterion for statistical significance for all analyses was set at P = 0.05.

RESULTS

Among groups of SS, YS showed the maximum pain intensity at baseline and posttreatment. The outcome of treatment was most successful in NS and least in FS. The number of patients who had gotten "better" after treatment was significantly highest in NS. There was no significant difference between groups of ND with respect to pain intensity, treatment outcome, or "better" patients.

CONCLUSIONS

Among Indian patients with TMD, smokers reported significantly greater pain intensity and poorer response to treatment than NS. Pain intensity or treatment outcome was independent of ND.

[Systematizing support in cessation smoking to improve care for cancer patients]

Approximately 20% of cancer patients smoke at diagnosis (all localizations included), and over two thirds continue despite the therapeutic management of their cancer, especially when cancer is not associated with tobacco. The impact of smoking on quality of care for patients is actually not enough considered. A literature review conducted by the French National Cancer Institute emphasizes the importance of tobacco cessation to improve the prognosis (decreased mortality from all causes and specific); to reduce the risk of second primary cancers; to reduce per- and post-surgical risks as long as some toxicities related to treatments and to improve the quality of physical and mental life of patients. It is important that a communication with the patient takes place at the beginning of the treatment to impact the smoking behavior. All oncology health professionals should deliver a clearly and personalized cessation advice in the light of scientific data and ensure that smoking cessation help will be offered to the patient.

Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy

Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.

Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research

Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.

Post-operative smoking status in lung and head and neck cancer patients: association with depressive symptomatology, pain, and fatigue

OBJECTIVE

An estimated 35-50% of lung and head and neck cancer patients are smoking at diagnosis; most try to quit; however, a substantial proportion resumes smoking. As cancer treatments improve, attention to the effects of continued smoking on quality of life in the survivorship period is increasing. The current study examines if smoking abstinence following surgical treatment is associated with better quality of life.

METHODS

Participants were 134 patients with head and neck or lung cancer who received surgical treatment. Smoking status and indices of quality of life (depressive symptoms, fatigue, and pain) were assessed at the time of surgery (baseline) and at 2, 4, 6, and 12 months post-surgery. Analyses were performed using a generalized estimating equations approach. A series of models examined the correlation between smoking status and post-surgery quality of life while adjusting for demographics, clinical variables, and baseline smoking status and quality of life.

RESULTS

Continuous post-surgery abstinence was associated with lower levels of depressive symptoms and fatigue; however, the relationship with fatigue became nonsignificant after adjusting for baseline fatigue and income. There was no significant relationship observed between smoking status and pain.

CONCLUSIONS

Findings add to a growing literature showing that smoking cessation is not associated with detrimental effects on quality of life and may have beneficial effects, particularly with regard to depressive symptoms. Such information can be used to motivate smoking cessation and continued abstinence among cancer patients and increase provider comfort in recommending cessation.

Pain experiences among a population-based cohort of current, former, and never regular smokers with lung and colorectal cancer

BACKGROUND

Smoking and pain are prevalent and comorbid among patients with cancer. Limited work has compared pain experiences among current, former, and never (regular) smokers with lung and colorectal cancer.

METHODS

We studied pain experiences of patients with lung (n = 2390) and colorectal (n = 2993) cancer participating in the multi-regional Cancer Care Outcomes Research and Surveillance study. We examined reports of pain, pain treatment, pain severity, and pain-related interference within each cancer group by smoking status, adjusting for demographic, psychosocial, and cancer characteristics.

RESULTS

Among lung cancer patients, current smokers reported pain and receiving pain treatment more often than former smokers. Never smokers did not differ from current and former smokers on endorsement of pain; however, they reported pain treatment less often than their counterparts. Current smokers reported greater pain severity than former smokers after adjusting for other contributing factors; however, no differences were detected between current and never smokers. There were no differences in pain-related interference. Among colorectal cancer patients, current smokers reported pain and pain treatment more often than former and never smokers; however, the latter 2 groups did not differ. Current smokers also reported greater pain severity than never smokers after adjustments; however, no differences were detected between current and former smokers. An identical pattern of findings was observed for pain-related interference.

CONCLUSIONS

Many smokers with lung and colorectal cancer experience pain following a cancer diagnosis. Future work should assess if comprehensive smoking cessation treatments that address pain can reduce pain and facilitate smoking cessation among patients with cancer.

Predictors of pain among patients with head and neck cancer

OBJECTIVE To determine predictors of pain 1 year after the diagnosis of head and neck cancer. DESIGN Prospective, multisite cohort study. SETTING Three academically affiliated medical centers. PATIENTS The study population comprised 374 previously untreated patients with carcinoma of the upper aerodigestive tract. MAIN OUTCOME MEASURES Participants were surveyed before treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the 36-Item Short-Form Instrument (SF-36) bodily pain score 1 year after diagnosis. RESULTS The mean SF-36 bodily pain score at 1 year was 65, compared with 61 at the time of diagnosis (P = .004), and 75, the population norm (lower scores indicate worse pain). Variables independently associated with pain included pretreatment pain score (P &lt; .001), less education (P = .02), neck dissection (P = .001), feeding tube (P = .05), xerostomia (P &lt; .001), depressive symptoms (P &lt; .001), taking more pain medication (P &lt; .001), less physical activity (P = .02), and poor sleep quality (P = .006). The association between head and neck cancer pain and current smoking and problem drinking did not reach significance (P = .07 and P = .08, respectively). CONCLUSIONS Aggressive pain management may be indicated for patients with head and neck cancer who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco use, and alcohol abuse may also reduce pain and improve quality of life among patients with head and neck cancer.

The prevalence of smokers within chronic pain patients and highest pain levels versus comparison groups

OBJECTIVES.: The objectives of this study were to (1) compare the prevalence of smoking within chronic pain patients (CPPs) to community non-patients without pain (CNPWP), community patients with pain (CPWP), and acute pain patients (APPs); and (2) compare smokers to nonsmokers within CPPs, APPs, and CPWP for highest pain level. DESIGN.: CNPWP, CPWP, APPs, and CPPs were compared to each other for smoking status (nonsmoker, less than one pack per day, one pack/day or more, any amount per day). Within CPWP, APPs, and CPPs, smokers were also compared to nonsmokers by t-test for highest reported pain level. For both analyses, sub-analyses were performed controlling for age or gender, or race or education. RESULTS.: Utilizing all available patients, the prevalence of smokers within CPPs was significantly greater vs each of the comparison groups (CNPWP, CPWP, APPs). In the sub-analyses, only CPPs who were 38 or younger or male or White, or had some college or above were at greater risk than CPWP for smoking one pack or greater per day. CPP smokers were not significantly more likely than nonsmokers to have higher pain, and this was confirmed in the sub-analyses. CONCLUSIONS.: The prevalence of smokers could be significantly greater within CPPs vs CPWP. CPPs who smoke do not have higher levels of pain than nonsmoking CPPs.

Distinguishing features of cancer patients who smoke: pain, symptom burden, and risk for opioid misuse

Although many cancer patients who have pain are smokers, the extent of their symptom burden and risk for opioid misuse are not well understood. In this study we analyzed records of patients being treated for cancer pain, 94 of whom were smokers and 392 of whom were nonsmokers, to determine smoking status group differences. Smokers had significantly higher pain intensity, fatigue, depression, and anxiety than nonsmokers (independent samples t-tests P < .002). Smokers were at higher risk for opioid misuse based on the short form of the Screener and Opioid Assessment for Patients with Pain (SOAPP). Specifically, smokers had more frequent problems with mood swings, taking medications other than how they are prescribed, a history of illegal drug use, and a history of legal problems (chi-square tests P ≤ .002). Changes in pain and opioid use were examined in a subset of patients (146 nonsmokers and 46 smokers) who were receiving opioid therapy on at least 2 of the 3 data time points (consult, follow-up 1 month after consult, follow-up 6 to 9 months after consult). Results based on multilevel linear modeling showed that over a period of approximately 6 months, smokers continued to report significantly higher pain than nonsmokers. Both smokers and nonsmokers reported a significant decline in pain across the 6-month period; the rate of decline did not differ across smokers and nonsmokers. No significant difference over time was found in opioid use between smokers and nonsmokers. These findings will guide subsequent studies and inform clinical practice, particularly the relevancy of smoking cessation.

PERSPECTIVE

This article describes pain, symptom burden, and risk for opioid misuse among cancer patients with pain across smoking status. Smoking appears to be a potential mechanism for having an increased pain and symptom burden and risk for opioid misuse. This improved understanding of cancer pain will inform clinical practice.

Variation in the gene TAS2R13 is associated with differences in alcohol consumption in patients with head and neck cancer

Variation in responsiveness to bitter-tasting compounds has been associated with differences in alcohol consumption. One strong genetic determinant of variation in bitter taste sensitivity is alleles of the TAS2R gene family, which encode chemosensory receptors sensitive to a diverse array of natural and synthetic compounds. Members of the TAS2R family, when expressed in the gustatory system, function as bitter taste receptors. To better understand the relationship between TAS2R function and alcohol consumption, we asked if TAS2R variants are associated with measures of alcohol consumption in a head and neck cancer patient cohort. Factors associated with increased alcohol intake are of strong interest to those concerned with decreasing the incidence of cancers of oral and pharyngeal structures. We found a single nucleotide polymorphism (SNP) located within the TAS2R13 gene (rs1015443 [C1040T, Ser259Asn]), which showed a significant association with measures of alcohol consumption assessed via the Alcohol Use Disorders Identification Test (AUDIT). Analyses with other SNPs in close proximity to rs1015443 suggest that this locus is principally responsible for the association. Thus, our results provide additional support to the emerging hypothesis that genetic variation in bitter taste receptors can impact upon alcohol consumption.

Taste damage (otitis media, tonsillectomy and head and neck cancer), oral sensations and BMI

Otitis media and tonsillectomy are associated with enhanced palatability of energy dense foods and with weight gain. Otitis media can damage the chorda tympani nerve (CN VII); tonsillectomy and head and neck radiation treatment can damage the glossopharyngeal nerve (CN IX). Both of these nerves function prominently in taste sensation. The present study utilizes these sources of damage to study central interactions among the nerves that mediate oral sensations. Mild damage restricted to one of these nerves can actually intensify sensations evoked from undamaged nerves (i.e., whole-mouth taste, oral tactile sensations evoked by fats and irritants). These intensifications may result from disruption of central inhibitory taste circuits, as taste damage appears to disinhibit other oral sensory nerves. In addition, mild damage restricted to one taste nerve can intensify odors perceived from foods in the mouth during chewing and swallowing (i.e., retronasal olfaction); this may be a secondary consequence of the intensification of whole-mouth taste. Damage to both nerves leads to widespread oral sensory loss. At present, the link between sensory alterations and weight gain has not been established for adults (e.g., does increased fat preference occur in individuals with oral sensory intensifications, those with losses, or both?). Finally, pain in non-oral locations is also related to taste loss. When participants rated "the most intense pain of any kind they had ever experienced," those with the greatest taste loss gave the highest ratings. These effects suggest that taste loss significantly influences long-term health outcomes.

Pain, nicotine, and smoking: research findings and mechanistic considerations

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Prescription patterns of analgesics in the last 3 months of life: a retrospective analysis of 10202 lung cancer patients

BACKGROUND

To describe the prescription patterns of analgesics during the last 3 months of life in lung cancer and to determine the associated factors.

METHODS

Data on lung cancer patients (N=10,202) who died during 2000-2008 were extracted from the General Practice Research Database (GPRD). This database records prescriptions of patients received from UK general practices (GP), but not those from non-GP routes. Prescription prevalences were estimated. The associated factors were investigated using log-binomial regression.

RESULTS

The overall prescription prevalences were 50.4% (95% confidence interval (CI): 49.4-51.4%) for level 1 (e.g., paracetamol), 34.1% (95% CI: 33.2-35.0%) for level 2 (weak opioids), and 55.5 % (95% CI: 54.5-56.4%) for level 3 analgesics (strong opioids). Prescription prevalence of analgesics of all levels showed an increasing trend over the period 2000-2008 (annual increases range: 1.1-1.5%) but a decreasing trend with age (average decrease per group range: -5.8 to -1.8%). Patients in the older age groups were less likely to be prescribed level 3 analgesics than those in the younger age groups (PR('90+' vs '<50')=0.55 (95% CI: 0.45-0.67); PR('80-89' vs '<50')=0.73 (95% CI: 0.66-0.79); PR('70-79' vs '<50')=0.84 (95% CI: 0.77-0.90)).

CONCLUSION

Analgesics have been increasingly prescribed in lung cancer. However, analgesics, especially at level 3, were relatively under-prescribed to people older than 70 years, warranting further investigation.

A smoking cessation program as a resource for bladder cancer patients

BACKGROUND

Continued tobacco use following a bladder cancer (CaB) diagnosis puts patients at risk for other tobacco-associated diseases and has also been associated with heightened risks of treatment-related complications, tumour recurrence, morbidity and mortality. Our aim was to determine if patients with CaB who continue to smoke warrant a smoking cessation program as a resource for improving their prognosis and long-term health.

METHODS

A cross-sectional quantitative questionnaire-based study was performed between January and April 2009. We surveyed patients with a pathologically confirmed diagnosis of CaB during their cystoscopy appointments at a single cancer centre.

RESULTS

One hundred patients completed the survey with 72% of them admitting to smoking in their lifetime. A third of respondents smoked at the time of their diagnosis; 76% of patients who had been active smokers at the time of their diagnosis (n = 33) reported smoking at some point thereafter and 58% continued to smoke. Among continued smokers, they were classified in the following categories: 26% were in "precontemplation," 5% in "contemplation," 16% in "preparation," and 53% in "action;" 37% of patients who continued to smoke were interested in a hospital-based smoking cessation program. Overall, 70% reported smoking as a risk factor for a poor CaB prognosis. The two most common barriers to quitting were "trouble managing stress and mood" and "fear of gaining weight."

CONCLUSION

Based on the data from our centre, patients with CaB who continue to smoke after their diagnosis warrant a smoking cessation program as a resource for improving prognosis and long-term health. Further research should focus on establishing an efficacious and cost-effective program that provides these patients with the resources they need to quit smoking.