The Frequency of Alcoholism in Patients With Advanced Cancer Admitted to an Acute Palliative Care Unit and a Home Care Program

Abstract

Context. Cancer patients with a history of alcoholism may be problematic. The frequency of alcoholism among patients with advanced cancer has never been reported in Italy or other European countries.Objectives. The aim of this prospective study was to determine the frequency of alcoholism, assessed with a simple and validated instrument, among patients with advanced cancer who were referred to two different palliative care settings: an acute inpatient palliative care unit (PCU) of a comprehensive cancer center in a metropolitan area and a home care program (HCP) in a territorial district, localized in the mountains of Italy.Methods. A consecutive sample of patients admitted to an inpatient PCU and to an HCP was assessed for a period of eight months. Each patient who agreed to be interviewed completed the Cut down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire. Patients were then interviewed informally to gather information about their history with alcohol.Results. In total, 443 consecutive patients were surveyed; data from 249 to 194 patients were collected in the PCU and HCP, respectively, in the eight-month period. The mean age was 66.4 (SD 12.7) years, and 207 were males. The mean Karnofsky level was 54.2 (SD 14.6). Eighteen patients were CAGE positive (4.06%). Males (Pearson Chi-squared, P ¼ 0.027) and younger patients (analysis of variance test, P ¼ 0.009) were more likely to be CAGE positive. Informal interviews revealed that 17 patients (3.83%) were alcoholics or had a history of alcoholism, and that alcoholism was strongly correlated with CAGE (Pearson Chisquared, P < 0.0001). Conclusion. Only a minority of patients were CAGE positive, with a similar frequency in the PCU and HCP settings. CAGE-positive patients were more likely to be male and younger, independent of diagnosis and performance status. CAGE was positively correlated with informal interviews for detecting alcoholism. As CAGE patients express more symptom distress, it is important to detect this problem with a simple tool that has a high sensitivity and specificity and is easy to use even in patients with advanced disease. J Pain Symptom Manage 2015;49:254e257.

Alcohol and drug use disorders in patients with cancer and caregivers: effects on caregiver burden

“…There have been a number of retrospective studies assessing the prevalence of alcohol use disorders in patients with advanced cancer in North America and Europe 6–11. This is reported as being 4%–38% using the CAGE questionnaire.…”

The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management

“…The term 'chemical coping' was coined by Bruera et al to reflect higher opioid dose usage in cancer patients who had a positive CAGE screen [80]. A positive CAGE screen (score ≥ 2/4) is reported in approximately 4-17% of cancer patients in palliative care settings [81,82]. Based on CAGE positivity, chemical coping is associated with higher symptom distress levels, higher opioid dosing, and more prolonged opioid use [81,83,84].…”

“…Based on CAGE positivity, chemical coping is associated with higher symptom distress levels, higher opioid dosing, and more prolonged opioid use [81,83,84]. Prevalence rates of addictive behavior in the 4-23.2% range have been reported in studies of the ECS-CP, rESS, and related studies included as core studies in this review [19,[23][24][25]28,[31][32][33]35,82]. A remarkably wide prevalence range (0-50%) was reported in one multisite study [28].…”

The complex problem of pain management in patients with advanced cancer disease addicted to alcohol - the psychotherapist’s perspective

“…Ból jest objawem występującym u ok. połowy chorych na nowotwory oraz u ponad 65% chorych w ich zaawansowanym stadium, istotnie obniżającym jakość życia [1]. Alkoholizm stwierdzany jest u 4-28% chorych w zaawansowanym stadium cho-roby nowotworowej objętych opieką paliatywną [2,3]. Leczenie bólu przewlekłego u osób z uzależnieniem od substancji psychoaktywnych jest złożonym i trudnym zagadnieniem.…”