Cancer survivors with pain more likely to use tobacco, cannabis
Key takeaways:
- Cancer survivors experiencing pain smoked cigarettes and used cannabis more often than survivors without pain.
- Alcohol use appeared less common among survivors experiencing pain.
Pain may influence cancer survivors’ decisions to use tobacco or cannabis, according to results of a retrospective analysis.
Survivors who reported higher recent pain intensity more often used cigarettes, e-cigarettes and cannabis products. Results also showed a significant association between chronic pain and cigarette use.
However, survivors who experienced recent or chronic pain drank less alcohol than those with recent or chronic pain.
“Many are aware that pain and opioid use are important issues in cancer survivorship,” Jessica M. Powers, PhD, postdoctoral research fellow at Northwestern University Feinberg School of Medicine, told Healio. “These findings and the larger literature show us it is also important to think about nonopioid substance use — including tobacco — among cancer survivors with chronic pain.”
Background and methods
Approximately 30% of cancer survivors — and about 50% of those with advanced disease — experience chronic pain, according to study background.
“We know that pain and substance use are important issues for cancer survivors because they can seriously affect their health and quality of life,” Powers said. “Many cancer survivors experience chronic pain, either from cancer itself or from cancer treatment.
“Substance use, especially tobacco use, can increase risk for cancer coming back or for developing new health problems, like heart or lung disease,” Powers added. “We have a strong literature in the general population showing that pain predicts greater likelihood of using tobacco, cannabis and other substances. However, cancer survivors have often been excluded from these studies.”
Powers and colleagues used two national datasets to conduct their study.
They evaluated Wave 6 (March-November 2021) of the Population Assessment of Tobacco and Health Study (PATH) for the first portion of their research, which focused on impact of recent pain. They used the 2020 National Health Interview Survey (NHIS) for the second part, which focused on the impact of chronic pain.
All participants had self-reported history of cancer.
The PATH evaluation included 1,252 adults (59.9% aged 65 years or older; 87.9% white; 54.87% women).
The NHIS evaluation included 4,130 adults (mean age, 65.55 years; 56.3% women; 83.28% white).
Researchers defined cigarette use as individuals smoking more than 100 cigarettes in their lifetime and currently smoking. They defined e-cigarette use as current use of any electronic nicotine product, and they defined cannabis and alcohol use as use within the previous 30 days.
The association of nonopioid substance use and pain among cancer survivors served as the primary endpoint. The relationship between pain and substance use with other treatment-related symptoms, emotional and mental health, perception of physical health, and quality of life served as secondary endpoints.
PATH results
The analysis of the PATH cohort showed survivors who experienced greater pain intensity in the previous week had a higher likelihood of smoking cigarettes (adjusted OR = 1.34; 95% CI, 1.26-1.42), using e-cigarettes (adjusted OR = 1.22; 95% CI, 1.07-1.39) and using cannabis (adjusted OR = 1.17; 95% CI, 1.09-1.26).
However, survivors who experienced greater pain intensity in the past week drank less alcohol (adjusted OR = 0.89; 95% CI, 0.85-0.95).
Past-week pain intensity appeared independently associated with fatigue, emotional problems, and worse self-perception of physical health, mental health, overall health and quality of life (P < .001).
Cigarette use appeared independently associated with fatigue (P < .01), emotional problems (P < .004), and worse self-perception of physical health, mental health, overall health and quality of life (P < .001).
Cannabis correlated with worse perception of mental health (P = .002).
Conversely, alcohol use appeared linked with improved perception of overall health and physical health (P < .001) and quality of life (P = .004).
NHIS results
Approximately one-third (35.81%) of the NHIS cohort had chronic pain.
Survivors with chronic pain had a higher likelihood of smoking cigarettes than those without chronic pain (adjusted OR = 1.65; 95% CI, 1.25-2.18).
However, results showed an association between chronic pain and less alcohol consumption (adjusted OR = 0.69; 95% CI, 0.58-0.81).
Chronic pain appeared associated with fatigue, difficulty falling and staying asleep, anxiety, depression, and worse self-perception of overall health (P < .001).
Smoking cigarettes also correlated with fatigue and difficulty falling asleep (P = .001), and difficulty staying asleep, anxiety, depression and worse self-perception of overall health (P < .001).
Alcohol use had associations with reduced fatigue (P = .001) and better perception of overall health (P < .001), but also with difficulty staying asleep (P = .017).
Next steps
“Because pain and substance use are interconnected among cancer survivors, it’s essential to focus on treating both together in cancer care,” Powers said. “Pain can drive substance use, and substance use can worsen pain and cause additional negative health effects, creating a cycle that’s hard to break. [Although] cancer survivors might smoke cigarettes or use substances to get immediate relief from their pain and cope with other symptoms, this can be incredibly harmful for their health by reducing the effectiveness of cancer treatments and increasing risk for cancer recurrence.”
Researchers acknowledged study limitations, including use of self-reported data.
“This research shows that we need to think about developing interventions focused on treating both pain and substance use together for cancer survivors,” Powers said. “We also need to focus on increasing access to alterative pain management strategies in cancer survivorship, so survivors feel more confident in managing pain and are less likely to turn to cigarettes or substances to cope with pain. To do this, we also need to consider policy-level changes which increase access to evidence-based treatments for pain and substance use.”
For more information:
Jessica M. Powers, PhD, can be reached at jessica.powers@northwestern.edu.
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