Abstract 683: Impact of smoking cessation and anxiety on hypersensitivity reactions in cancer patients
Authors: Barry Devon C. , Hartung Natalie , Williams Casey 
Published: July 2021

Abstract
Purpose: Little is known about the physiological impact of smoking cessation on a patient with cancer. Smoking cessation immediately after a cancer diagnosis likely induces a nicotine withdrawal syndrome that drastically alters catecholamine production and activity and may negatively impact a patient's mental health. Studies have demonstrated that stress-related catecholamines may negatively affect cancer progression, but data regarding the acute effects on immune system function is lacking. The molecular mechanisms of hypersensitivity to taxane chemotherapy are not well defined, but for a majority of patients that develop a reaction to paclitaxel, the reaction occurs with the first or second infusion. Our hypothesis is patients that are highly anxious are more likely to develop a reaction to chemotherapy such as paclitaxel, particularly if they have a recent history of nicotine addiction and are trying to quit.
Methods: A retrospective chart review of patients with breast or gynecological cancers was conducted at Avera Cancer Institute. A total of 58 female patients with a history of a hypersensitivity reactions to taxane chemotherapy were included. Data collected on patient characteristics included, smoking history, history of depression or anxiety, and onset of hypersensitivity reaction. The primary outcome was strength of association between nicotine exposure and onset of reaction, based upon odds ratio and relative risk. Secondary outcomes included the effects of anxiety and nicotine withdrawal on clinical outcomes and anxiety-related impact on therapeutic execution.
Results: Of the 58 patients with a history of taxane hypersensitivity, 12 (20.7%) had a diagnosis of anxiety, 19 (32.8%) were former smokers, and 2 (3.4%) were current smokers. Among the 12 patients who had a diagnosis of anxiety at the time of their reaction, 5 (41.7%) were documented to be former or current smokers. Patients previously exposed to nicotine were found to be more likely to experience a hypersensitivity reaction within cycle 1 of chemotherapy (Odds Ratio 1.26). The risk of experiencing a reaction within the first cycle was found to be 16% higher in those who were exposed to nicotine compared to those who were not.
Conclusion: The results of our analysis indicate that recent nicotine addiction and anxiety may increase the likelihood of a taxane hypersensitivity reaction during cycle 1. Those without a smoking history mainly experienced reactions during cycles 2, 3, or 4, which reinforced our findings. Limitations associated with this study include small sample size and the challenges of interpreting clinical notes in the electronic medical record. A larger analysis is required to confirm our results and data collection is ongoing.
Citation Format: Devon C. Barry, Natalie Hartung, Casey Williams. Impact of smoking cessation and anxiety on hypersensitivity reactions in cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 683.