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 non-smokers, to determine smoking status group differences. Smokers had significantly higher pain intensity, fatigue, depression, and anxiety than non-smokers (Independent samples t-tests P <0.002). 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 endorsed more frequent problems with mood swings, taking medications other than how they are prescribed, history of illegal drug use and history of legal problems (Chi-square tests P ≤0.002). Changes in pain and opioid use were examined in a subset of patients (146 non-smokers and 46 smokers) who were receiving opioid therapy on at least two of the three data time points (consult, follow-up 1 month after consult, follow-up 6-9 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 non-smokers. Both smokers and non-smokers reported a significant decline in pain across the six-month period; the rate of decline did not differ across smokers and non-smokers. No significant difference over time was found in opioid use between smokers and non-smokers. These findings will guide subsequent studies and inform clinical practice, particularly the relevancy of smoking cessation.
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