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What’s the relationship between cancer survivors’ tobacco use, symptom burden, and motivation to quit smoking?


Study’s findings may help inform tobacco cessation support efforts.

In a recent study, current smoking and vaping were associated with a higher burden of symptoms among adult cancer survivors, but these symptoms were not related to survivors’ desire to quit smoking. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Continued smoking after a cancer diagnosis lowers survival rates, increases the likelihood of additional cancers, and decreases the effectiveness of cancer therapies. Understanding the relationship between tobacco use and the symptoms that patients experience may help clinicians tailor tobacco cessation interventions for individuals with cancer.

To study this relationship, Sarah Price, PhD, of the Wake Forest University School of Medicine, and her colleagues analyzed data on 1,409 adults who had a history of cancer and were participating in Wave 5 of the US FDA Population Assessment of Tobacco and Health (PATH) Study, which gathered detailed tobacco use information from a nationally representative sample of adults from December 2018 to November 2019.

Participants’ answers to questionnaires revealed that 14% and 3% of those who had been diagnosed with cancer currently smoked cigarettes or vaped, respectively. Current smoking was associated with greater fatigue, pain, emotional problems, and worse quality of life compared to participants who previously smoked and participants who never smoked. Current vaping was associated with greater fatigue, pain, and emotional problems, but not worse quality of life. These findings add to a growing body of evidence that continued smoking following a cancer diagnosis is a risk factor for worse outcomes.

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

“Our finding 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 clinicians who treat them,” said Dr. Price. “Future research should also explore whether better management of cancer symptoms like pain, fatigue, or emotional problems helps survivors quit smoking.”

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout,

Full Citation:
“Tobacco Use and Cancer-Related Symptom Burden: Analysis of the United States Population Assessment of Tobacco and Health Study.” Sarah N. Price, Amanda M. Palmer, Lisa M. Fucito, Evan M. Graboyes, Nathaniel L. Baker, Alana M. Rojewski, and Benjamin A. Toll. CANCER; Published Online: May 22, 2023 (DOI: 10.1002/cncr.34746). 

URL Upon Publication:

Author Contact: Myra Wright, of the Wake Forest University School of Medicine Communications Office, at or +1 (336) 716-4587.

About the Journal     
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow us on Twitter @JournalCancer.

About Wiley
Wiley is one of the world’s largest publishers and a global leader in scientific research and career-connected education. Founded in 1807, Wiley enables discovery, powers education, and shapes workforces. Through its industry-leading content, digital platforms, and knowledge networks, the company delivers on its timeless mission to unlock human potential. Visit us at Follow us on FacebookTwitterLinkedIn and Instagram.

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