Association Between Tobacco Use, Symptom Expression, and Alcohol and Illicit Drug Use in Advanced Cancer Patients

154 Background: Our aim was to determine the association between smoking status and symptom expression, opioid use, alcoholism, and illicit drug use in advanced cancer patients. Methods: We retrospectively reviewed 560 consecutive charts from the outpatient Supportive Care Center and identified 300 advanced cancer patients who completed a comprehensive smoking questionnaire. Data on the Edmonton Symptom Assessment Scale (ESAS), morphine equivalent daily dose (MEDD), CAGE (Cut Down, Annoyed, Guilty, Eye Opener) questionnaire for alcoholism screening, and history of illicit drug use were collected. Results: Among 300 advanced cancer patients, 119 (40%) were never-smokers, 148 (49%) were former smokers, and 33 (11%) were current smokers. Compared with never-smokers, current smokers were more likely to be men (58% vs. 29%, P=0.004), report a higher pain expression (median 7.0 vs. 5.0 by the ESAS, P=0.007), be CAGE positive (≥2 yes response) (42% vs. 3%, P<0.001), and have a history of illicit drug use (33% vs. 3%, P<0.001). Compared with never-smokers, former smokers were more likely to be men (60% vs. 29%, P<0.001), have head and neck cancer or lung cancer (30% vs. 13%, P=0.001), be CAGE positive (21% vs. 3%, P<0.001), and have a history of illicit drug use (16% vs. 3%, P<0.001). Current smokers reported a higher pain expression than former smokers (median 7.0 vs. 6.0 by the ESAS, P=0.01), had higher CAGE positivity (42% vs. 21%, P=0.01) and more frequent illicit drug use (33% vs. 16%, P=0.03). The MEDD and the timing of palliative care referral were not significantly different between current or former smokers compared with never-smokers. However, a higher proportion of current smokers were receiving opioids with MEDD ≥30mg at the time of palliative care consultation compared with never-smokers (70% vs. 52%, P=0.08). Conclusions: Our study suggests that current tobacco use is associated with a higher pain expression. In addition, any history of tobacco use is associated with a history of illicit drug use and alcoholism. Advanced cancer patients who smoked cigarettes may be at an increased risk for chemical coping or stronger opioid utilization and further studies are needed.

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

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.65 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 65-65

Author(s):

Rony Dev ◽

Yu Jung Kim ◽

Akhila Sunkepally Reddy ◽

David Hui ◽

Kimberson Cochien Tanco ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Tobacco Use ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Maladaptive Coping ◽

Increased Risk ◽

Pain Expression ◽

Former Smokers ◽

Never Smokers

65 Background: Cancer patients who smoke have been reported to have higher pain expression and increased risk for opioid abuse. The purpose of our study is to evaluate the association between tobacco use, symptom expression, and maladaptive coping in advanced cancer patients. Methods: We prospectively enrolled advanced cancer patients evaluated in an outpatient Supportive Care Center and collected data on patient demographics, cancer diagnosis, morphine equivalent daily dose (MEDD), cigarette smoking status using Behavioral Risk Factor Surveillance System, symptom expression as measured by Edmonton Symptom Assessment Scale, Cut down/Annoyed/Guilty/Eye opener (CAGE alcoholism questionnaire), short form Screener and Opioid Assessment for Patients with Pain (SOAP-SF) survey, and Brief COPE Questionnaire. Results: Among399 patients, 195 (49%) were never smokers, 158 (40%) former smokers, and 46 (11%) current smokers. The most common malignancies were gastrointestinal (21.1%) and breast (19.5%). Never smokers were more likely to be female (p = 0.005). Current smokers expressed significantly higher pain scores at consultation than former or never smokers [median 7 vs. 6 vs. 5, respectively (p = 0.015)], increased MEDD (median 90 vs. 60 vs. 50, p = 0.002), and more likely to screen CAGE positive (33% vs. 24% vs. 8.7%, p < 0.0001). Compared with former and never smokers, current smokers were significantly more likely to cope with substance use (p = 0.02), denial (p = 0.007), and self-blame (< 0.0001), while both current and former smokers significantly more likely to use venting (p = 0.04). In addition, current smokers compared with former and never smokers were significantly more likely screen positive (≥ 4) on the SOAP-SF survey (74% vs. 13% vs. 9.3%, p = < 0.0001) and clinicians rated patients to be at higher risk for maladaptive coping (6.5% vs 2.5% vs. 1.5%, p = 0.003). Conclusions: In advanced cancer, current and former smokers were significantly more likely to have higher pain expression, CAGE positivity, and increased MEDD at consultation. In addition, a history of current or past tobacco use in advanced cancer patients was associated with increased risk of maladaptive coping.

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Symptom expression in advanced cancer patients admitted to hospice or home care with and without delirium

Internal and Emergency Medicine ◽

10.1007/s11739-018-1969-9 ◽

2018 ◽

Vol 14 (4) ◽

pp. 515-520 ◽

Cited By ~ 2

Author(s):

Sebastiano Mercadante ◽

Francesco Masedu ◽

Marco Maltoni ◽

Daniela De Giovanni ◽

Luigi Montanari ◽

...

Keyword(s):

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Expression ◽

Advanced Cancer Patients

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Association between alcoholism and symptom expression, patient symptom goals, and clinical response in advanced cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-019-05152-x ◽

2019 ◽

Vol 28 (7) ◽

pp. 3361-3369

Author(s):

Sebastiano Mercadante ◽

Claudio Adile ◽

Patrizia Ferrera ◽

Alessandra Casuccio

Keyword(s):

Clinical Response ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Patient Symptom

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The Role of Religiosity in Symptom Expression of Advanced Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211041349 ◽

2021 ◽

pp. 104990912110413

Author(s):

Sebastiano Mercadante ◽

Claudio Adile ◽

Marianna Ricci ◽

Marco Maltoni ◽

Giuseppe Bonanno ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Social Relationship ◽

Karnofsky Performance Status ◽

Depression Scale ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment Scale ◽

Relevant Role

Aim: The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. Methods: A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. Results: Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. Conclusion: The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.

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Pattern of Drug Use by Advanced Cancer Patients Followed at Home

Journal of Palliative Care ◽

10.1177/082585970101700106 ◽

2001 ◽

Vol 17 (1) ◽

pp. 37-40 ◽

Cited By ~ 12

Author(s):

Sebastiano Mercadante ◽

Fabio Fulfaro ◽

Alessandra Casuccio

Keyword(s):

Drug Use ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

At Home

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Financial distress and its impact on symptom expression in advanced cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-020-05507-9 ◽

2020 ◽

Vol 29 (1) ◽

pp. 485-490 ◽

Cited By ~ 1

Author(s):

Sebastiano Mercadante ◽

Federica Aielli ◽

Claudio Adile ◽

Giuseppe Bonanno ◽

Alessandra Casuccio

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Financial Distress ◽

Symptom Expression ◽

Advanced Cancer Patients

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Illicit drug use among Croatian university students

European Journal of Public Health ◽

10.1093/eurpub/ckz186.610 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

I Miskulin ◽

I Vcev ◽

I Gaspar ◽

A Juric ◽

A Barac ◽

...

Keyword(s):

Public Health ◽

Drug Use ◽

University Students ◽

Tobacco Use ◽

Illicit Drug ◽

Illicit Drug Use ◽

Health Issue ◽

Public Health Issue ◽

Global Public Health ◽

Student Sample

Abstract Background Illicit drug (ID) use among university students has been recognized as a global public health issue in recent years. It has been emphasized that during university years’ opportunities to experiment with ID increases due to the fact that this is a period of life characterized by transition, intense academic pressures as well as independence and separation from parental supervision. The aim of this study was to identify prevalence and characteristics of ID use among Croatian university students. Methods This was a multicentric, cross-sectional study that included five Croatian universities. A validated, anonymous online questionnaire containing questions regarding demographic and data regarding ID, alcohol and tobacco use was self-administered to cross-faculty representative student sample of University of Osijek, Zagreb, Rijeka, Split and Zadar during November 2018. Results The study sample included 888 students, the average age being 21.9 years (range 18-34); 18.4% males and 81.6% females. The overall prevalence of ID use among Croatian university students was 29.8%. The ID use was more frequent among males (p = 0.001) and among students who repeated the study year (p < 0.001). The study further revealed that there were 48.4% students who tried any type of ID during life. The majority of students tried ID for the first time during high school period (34.1%), when socializing with friends in open spaces such as parks (20.6%) and main reason for usage was to have fun (40.5%). The study also showed that there were statistically significant Spearman rank correlations between ID and alcohol use (p < 0.001) as well as between ID and tobacco use (p < 0.001). Conclusions The usage of ID is highly prevalent among Croatian university students in participating universities. Further studies are needed to identify and explain other possible risk factors for this phenomenon. Key messages Illicit drug use is an important but poorly investigated public health issue among Croatian university students. Better understanding of specific characteristic and possible risk factor for illicit drug use among university student population will ensure development of preventive programs.

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Impact of tobacco and illicit drug use in the care of adolescent and young adults with sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18657 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18657-e18657

Author(s):

Rushad Machhi ◽

Amanda Marie Parkes

Keyword(s):

Substance Use ◽

Drug Use ◽

Tobacco Use ◽

Illicit Drug ◽

Illicit Drug Use ◽

Chemotherapy Dose ◽

Delays In Diagnosis ◽

Oncology Providers ◽

Current Tobacco ◽

Dose Reductions

e18657 Background: Despite adolescent and young adults (AYAs) representing the patient population most likely to initiate and use tobacco and illicit drugs, studies of their impact have thus far focused on older cancer patients or those in survivorship. As sarcomas often serve as a model for AYA care and are associated with poor psychosocial function, frequent delays in diagnosis, and outcomes related to chemotherapy dose density, we sought to understand the impact of tobacco and illicit drug use on diagnosis, chemotherapy delays and dose reductions, and no-show rates in AYAs with sarcoma. Methods: Retrospective chart review was performed on adult AYA patients (18-39 years) with sarcoma seen at least once in 2019 at the University of Wisconsin, identifying documentation of tobacco, marijuana, and other illicit drug use and comparing to pre-identified cancer outcomes including days from symptom onset to tissue diagnosis (with delay defined as > 120 days from symptoms to diagnosis), chemotherapy delays > 1 week and dose reductions, and appointment no-show rates. Current substance use was defined as use following cancer diagnosis. Results: We identified 46 AYAs with sarcoma, with documented tobacco use in 20% as current (9/46), 13% as former (6/46) and 67% as none (31/46). Marijuana and illicit drug use were less frequent at 17% (8/46) and 7% (3/46) respectively. Delayed diagnoses were more common in patients with current tobacco use (6/9, 67%) as compared with former or non-smokers (12/37, 32%, p = 0.12) and were seen in all patients with illicit drug use (3/3, 100%), as compared with only 35% without illicit drug use (15/43, p = 0.05). Of the 24 patients who received chemotherapy, chemotherapy delays and dose reductions were more common in current tobacco users at 86% (6/7) and 29% (2/7) respectively, as compared with patients with former or no tobacco use at 71% (12/17) and 18% (3/17) respectively. Chemotherapy dose reductions were also more common in patients with illicit drug use (2/3, 67%) versus no illicit drug use (3/21, 14%, p = 0.10). Appointment no-show rates were higher in current tobacco users versus former or non-smokers, with 44% (4/9) versus 27% (10/37) with a no-show rate > 5%. In patients with documented substance use, oncology providers documented 93% of tobacco use (14/15) but only 38% marijuana use (3/8) and 33% illicit drug use (1/3) and no oncology providers documented a cessation plan. Conclusions: Current tobacco and illicit drug use in AYAs with sarcoma were associated with delays in diagnosis, increased chemotherapy delays and dose reductions, and higher no-show rates, highlighting modifiable risk factors. Even more strikingly, oncology providers had low rates of documentation of marijuana and illicit drug use in AYAs and no documentation of plans for cessation, highlighting a lost opportunity and the need for more standardized substance use assessment and evidence-based cessation interventions for AYAs with cancer.

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