Behavioral predictors of pain control among adult cancer survivors: Examining the impact of smoking, physical activity, and alcohol consumption.

12048 Background: Cancer-related pain remains a prevalent and debilitating symptom among adult cancer survivors, substantially impairing quality of life. While pharmacologic therapies are central to pain management, growing evidence suggests that modifiable lifestyle behaviors may influence pain outcomes. This study examined the association between smoking status, alcohol consumption, physical activity, and pain control among adult cancer survivors in the United States. Methods: We conducted a cross-sectional analysis using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey of U.S. adults. The study population included adults aged ≥18 years with a history of cancer who reported physical pain attributable to cancer or its treatment. The primary outcome was self-reported pain control (controlled vs uncontrolled). Primary predictors included smoking status (current, former, never), heavy alcohol consumption (men >14 drinks/week; women >7 drinks/week), and physical activity in the past 30 days outside of regular employment. Multivariable logistic regression models were used to estimate odds ratios (ORs) with adjustment for age, sex, race/ethnicity, educational attainment, and household income. Sampling weights were applied to account for the complex survey design. Results: A total of 1,380 cancer survivors with cancer-associated pain were included. Most participants were aged ≥60 years (62.4%), female (63%), and non-Hispanic White (78.9%). Overall, 76% reported controlled pain, while 24% reported uncontrolled pain. Compared to current smokers, participants who had never smoked had significantly lower odds of having uncontrolled pain (OR=0.45; 95% CI 0.25 – 0.81, p=0.001). Former smokers had a 41% lower odds of having uncontrolled pain than current smokers (OR=0.59; 95% CI 0.33 – 0.94, p=0.04). Heavy alcohol consumption was not significantly associated with pain control (OR=1.03, 95% CI 0.48 – 2.21, p=0.94). Physical inactivity was significantly associated with poorer pain outcomes; participants who were inactive in the past 30 days had 72% higher odds of uncontrolled pain compared with those who engaged in physical activity (OR=1.72, 95% CI 1.11 – 2.67, p=0.01). Conclusions: Smoking and physical inactivity are significantly associated with poor pain control among adult cancer survivors. Incorporating smoking cessation and exercise promotion into survivorship care plans may enhance pain management and overall quality of life among cancer survivors.