Alcoholism Screening in Patients with Advanced Cancer: Impact on Symptom Burden and Opioid Use
Alcoholism Screening in Patients with Advanced Cancer: Impact on Symptom Burden and Opioid Use
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DOI：
10.1089/jpm.2008.0037
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发表时间：
2008-09-01
影响因子：
2.8
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
Parsons, Henrique A.;Delgado-Guay, Marvin Omar;Bruera, Eduardo
目的：酒精中毒是一种毁灭性的疾病，可导致患者和家庭痛苦，经常被低估。初步研究表明，这与症状表达增加和阿片类药物剂量上升有关。CAGE问卷是一种广泛使用的酒精中毒筛查工具。这项研究的目的是确定在姑息关怀门诊(PCOC)筛查酒精中毒阳性的患者的频率和特征。方法：我们回顾了665名参考PCOC的患者的连续图表，并收集了年龄、性别和癌症类型的数据。对于连续100例CAGE阳性(CAGE+)和100例CAGE阴性(CAGE-)患者，计算从晚期癌症诊断(AC)到PCOC的时间，并收集症状(Edmonton症状评定量表，ESAS)和吗啡当量日剂量(MEDD)。结果：665例患者中，598例(90%)可用CAGE。在598例患者中，100例(17%)为CAGE+。CAGE+患者更年轻(58岁比60岁，P<；0.0001)，主要是男性(68%比47%，P<；0.05)，头/颈部恶性肿瘤(24%比9%，P<；0.05)。CAGE+患者的转诊时间更早(AC后5+/-19个月比13+/-27个月，p<；0.0001)。在基线时，CAGE+患者的疼痛、睡眠、呼吸困难、幸福感和总的症状苦恼显著恶化。两组患者的症状都有相似的改善。CAGE+患者在转诊时(47/100比29/100，p<；0.05)和随访时(27/65比16/68，p<；0.05)更频繁地服用阿片类药物。在随访时，阿片类药物的剂量没有明显变化。结论：17%的患者是CAGE+。这些患者被转介到姑息治疗的时间更早，症状表现更多，使用阿片类药物的频率也更高。姑息治疗小组成功地改善了两组的症状控制，而没有阿片类药物剂量的增加。
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 +/- 19 versus 13 +/- 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.