Pain and smoking among cancer patients: the relationship is complex but the clinical implication is clear.
Pain and smoking among cancer patients: the relationship is complex but the clinical implication is clear.
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DOI：
10.1016/j.pain.2010.10.023
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发表时间：
2011-01
期刊：
影响因子：
7.4
通讯作者：
Bastian LA
中科院分区：
文献类型：
--
作者：
Bastian LA
疼痛是癌症及其治疗的一种常见且令人衰弱的并发症。最近的研究报告说，患有肺癌或头颈癌的持续吸烟者疼痛严重程度更高。Daniel等人。研究发现，在控制了年龄、教育程度、健康状况和其他癌症症状(如呼吸困难、疲劳和进食困难)后，确诊为肺癌的持续吸烟者报告中度或重度疼痛的可能性是从未吸烟者和既往吸烟者的1.6倍。洛根等人。研究发现，即使在控制了诊断阶段后，目前患有头颈癌的吸烟者报告的一般疼痛和疼痛相关干扰比从未吸烟者和既往吸烟者更高[8]。这些横断面研究的作者呼吁进行进一步的研究，以探索其他癌症患者中疼痛和吸烟的这种联系，并确定这种联系的方向性。研究人员面临的下一个问题是吸烟是否会增加疼痛，或者疼痛是否会导致更多的吸烟。在最新一期的《疼痛》中，Ditre和他的同事[6]利用横断面设计评估了疼痛和吸烟状况与各种癌症诊断之间的关系，这些癌症包括乳腺癌(35%)、肺癌(33%)、膀胱癌(6%)、卵巢癌(6%)、结肠癌(4%)和其他不常见的癌症。作者假设，在所有癌症诊断中，目前吸烟与更高的疼痛有关。这项研究的参与者(n=224)是即将开始门诊化疗的癌症患者。平均年龄为56岁，其中63%为女性，88%为白人。由于受试者被招募参加旨在改善化疗副作用的运动干预，因此该研究排除了无法参加适度运动的患者。作者发现，持续吸烟者报告的疼痛比从不吸烟者更严重，而且这种联系没有因癌症类型而异。持续吸烟者也报告说，与既往吸烟者或从不吸烟者相比，疼痛的干扰更大。在戒烟者中，观察到疼痛严重程度与戒烟年数呈负相关，这表明随着时间的推移，戒烟可能会导致疼痛减轻。Ditre等人的横断面研究的局限性。作者很好地描述了，包括无法确定因果关系和使用自我报告的吸烟状态，这一点没有得到生化验证的证实[6]。由于癌症患者有相当大的压力说他们不再吸烟，自我报告的吸烟状况可能会带来偏见。此外，由于功能状况较差的患者(那些不能参加适度运动的患者)被排除在外，这些发现对所有癌症患者的普适性有限。发现吸烟者患上这种疾病的可能性较小
Pain is a common and debilitating complication of cancer and its treatments. Recent studies have reported higher pain severity among persistent smokers with lung or head and neck cancers. Daniel et al. found that persistent smokers after a lung cancer diagnosis were 1.6 times more likely to report moderate or severe pain compared with never and former smokers after controlling for age, education, health status, and other cancer symptoms, such as dyspnea, fatigue, and difficulty eating [4]. Logan et al. found that current smokers with head and neck cancer reported higher general pain and pain-related interference than did never and former smokers, even after controlling for stage of diagnosis [8]. The authors of these cross-sectional studies called for further research to explore this association of pain and smoking among patients with other cancers and to determine the directionality of this relationship. The next question facing researchers is whether smoking increases pain or whether pain causes more smoking. In the current issue of Pain, Ditre and colleagues [6] utilized a cross-sectional design to assess the association of pain and smoking status for a variety of cancer diagnoses including breast (35%), lung (33%), bladder (6%), ovarian (6%), colon (4%) and other less common types. The authors hypothesized that current smoking would be associated with higher pain across all cancer diagnoses. Participants in the study (n= 224) were cancer patients about to begin out-patient chemotherapy. The mean age was 56 years, 63% were female and 88% were white. Because subjects were recruited for an exercise intervention designed to improve chemotherapy side effects, the study excluded patients who were unable to participate in moderate exercise. The authors found that persistent smokers reported more severe pain than never smokers and this association did not differ by cancer type. Persistent smokers also reported greater interference from pain than former smokers or never smokers. Among former smokers, an inverse relationship between pain severity and number of years since quitting was observed suggesting that quitting smoking may lead to reduced pain over time.The limitations of the cross-sectional study by Ditre et al. are well described by the authors and include the inability to determine causality and the use of self-reported smoking status, which was not confirmed by biochemical verification [6]. As there is considerable pressure for patients with cancer to say that they are no longer smoking, self-reported smoking status can introduce bias. Furthermore, because patients with poor functional status (those unable to participate in moderate exercise) were excluded, the generalizability of these findings to all patients with cancer is limited. The finding that smokers were less likely to have had
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影响因子：
5.3
作者：
Cooley, Mary E.;Sarna, Linda;Kotlerman, Jenny;Lukanich, Jeanne M.;Jaklitsch, Michael;Green, Sarah B.;Bueno, Raphael
通讯作者：
Bueno, Raphael
影响因子：
7.4
作者：
Ditre, Joseph W.;Gonzalez, Brian D.;Jacobsen, Paul B.
通讯作者：
Jacobsen, Paul B.
DOI：
10.1016/j.jpain.2009.09.006
发表时间：
2010-06
期刊：
The journal of pain
影响因子：
--
作者：
Logan HL;Fillingim RB;Bartoshuk LM;Sandow P;Tomar SL;Werning JW;Mendenhall WM
通讯作者：
Mendenhall WM
影响因子：
4
作者：
Daniel, Marcella;Keefe, Francis J.;Bastian, Lori A.
通讯作者：
Bastian, Lori A.
影响因子：
4.6
作者：
Ditre, Joseph W.;Brandon, Thomas H.
通讯作者：
Brandon, Thomas H.