Document Detail

Alcoholism screening in patients with advanced cancer: impact on symptom burden and opioid use.
MedLine Citation:
PMID:  18788955     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Alcoholism is a devastating disease that can cause patient and family suffering and is frequently underdiagnosed. Preliminary studies suggest that it is associated with increased symptom expression and opioid dose escalation. The CAGE questionnaire is a widely used tool for alcoholism screening. The purpose of this study was to determine the frequency and characteristics of patients who screen positive for alcoholism in a palliative care outpatient clinic (PCOC).
METHODS: We reviewed 665 consecutive charts of patients referred to the PCOC and collected data regarding age, gender, and type of cancer. For the first 100 consecutive CAGE positive (CAGE+) and 100 consecutive CAGE negative (CAGE-) patients, time from advanced cancer diagnosis (AC) to PCOC was calculated, and symptoms (Edmonton Symptom Assessment Scale, ESAS) and Morphine Equivalent Daily Dose (MEDD) were collected.
RESULTS: CAGE was available for 598 of 665 (90%) patients. Of 598 patients, 100 (17%) were CAGE+. CAGE+ patients were younger (58 versus 60 years, p < 0.05), predominantly male (68% versus 47%, p < 0.0001), and with head/neck malignancies (24% versus 9%, p < 0.05). CAGE+ patients were referred earlier (5 +/- 27 months after AC, p < 0.0001). At baseline, pain, sleep, dyspnea, well-being, and total symptom distress were significantly worse among CAGE+ patients. Both groups showed similar improvement in symptoms. CAGE+ patients were more frequently on opioids upon referral (47/100 versus 29/100, p < 0.05) and follow-up (27/65 versus 16/68, p < 0.05). At follow-up, opioid doses did not show significant changes.
CONCLUSION: Seventeen percent of the patients were CAGE+. These patients were referred earlier to palliative care, had more symptom expression, and were more frequently on opioids. The palliative care team successfully improved symptom control in both groups without opioid dose escalation.
Henrique A Parsons; Marvin Omar Delgado-Guay; Badi El Osta; Ray Chacko; Valerie Poulter; J Lynn Palmer; Eduardo Bruera
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of palliative medicine     Volume:  11     ISSN:  1557-7740     ISO Abbreviation:  J Palliat Med     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-15     Completed Date:  2008-12-17     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  9808462     Medline TA:  J Palliat Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  964-8     Citation Subset:  IM    
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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MeSH Terms
Aged, 80 and over
Alcoholism / diagnosis*,  epidemiology
Ambulatory Care Facilities
Analgesics, Opioid / therapeutic use*
Cost of Illness*
Mass Screening* / methods
Medical Audit
Middle Aged
Neoplasms / classification*,  physiopathology
Palliative Care
Texas / epidemiology
Young Adult
Grant Support
NR010162-01A1/NR/NINR NIH HHS; R01 CA122292-01/CA/NCI NIH HHS; R01 CA124481-01/CA/NCI NIH HHS
Reg. No./Substance:
0/Analgesics, Opioid

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