Study Analyzes Relationship Between Cancer Survivors’ Tobacco Use, Symptom Burden, and Motivation to Quit Smoking

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Investigators have found that current smoking and vaping may be associated with a higher burden of symptoms among adult cancer survivors but that these symptoms may not have had an impact on the desire to quit smoking. The new study was published by Price et al in Cancer.


Continued smoking after a cancer diagnosis has been shown to lower the rate of survival, increase the likelihood of developing additional cancer types, and decrease the effectiveness of cancer therapies. Understanding the relationship between tobacco use and the symptoms that patients experience may help physicians tailor tobacco cessation interventions for patients with cancer and cancer survivors.

Study Methods and Results

In the new study, the investigators analyzed the data of 1,409 patients with a history of cancer—who were participating in the U.S. Food and Drug Administration Population Assessment of Tobacco and Health (PATH) study—in order to better understand the relationship between smoking behavior, symptoms from smoking, and quitting. The investigators noted that the PATH study had gathered detailed tobacco use information from a nationally representative sample of patients from December 2018 to November 2019.

After reviewing the patients’ questionnaire responses, the investigators revealed that 14% and 3% of those who had been diagnosed with cancer currently smoked or vaped, respectively. Patients who currently smoked were found to have symptoms of greater fatigue, pain, and emotional problems as well as a reduced quality of life compared with those who quit smoking and those who never smoked. Additionally, current vaping was associated with greater fatigue, pain, and emotional problems, but not a reduced quality of life. The investigators suggested that their new findings supported a growing body of evidence that continued smoking following a cancer diagnosis may be a risk factor for worse patient outcomes.


There was no relationship between patients’ burden of symptoms and their interest in quitting smoking, their likelihood of quitting, or their attempts to quit in the past year.

“Our findings that greater symptom burden was not associated with reduced interest in quitting smoking directly contradicts common assumptions that patients with cancer are resistant to tobacco cessation treatment because of their symptom burden. If smoking cessation is viewed as part of cancer symptom management, it may be more acceptable to both patients and the [physicians] who treat them,” stressed lead study author Sarah Price, PhD, a postdoctoral fellow of cancer prevention and control in the Department of Social Sciences and Health Policy at the Wake Forest University School of Medicine. “Future research should also explore whether better management of cancer symptoms like pain, fatigue, or emotional problems helps survivors quit smoking,” she concluded.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.