Release: July 29, 2000
Contact: Kenneth Satterfield
703-519-1563
[email protected]
In San Francisco (7/28-8/2)
415-284-8082
HEAD AND NECK CANCER PATIENTS MORE PRONE TO ALCOHOLISM AND DEPRESSION THAN OTHER DISEASE VICTIMS
San Francisco, CA -- Despite the known association between alcohol use and the development of head and neck cancer, the prevalence of alcohol abuse and dependency is rarely reported in this patient population. A new study suggests that patients with head and neck cancer have a greater propensity for alcohol abuse and depression that patients with cancer in other parts of the body. Their conclusions recommend new strategies of treatment for head and neck surgeons.
The authors of the study, -- Prevalence of Alcohol Abuse, Mood Disorders, and Cognitive Impairment in Head and Neck Cancer Patients, -- are Judith Czaja McCaffrey MD, Michael Weitzner MD, Dimitra Kamboukas, MA, Gretchen Haselhuhn, MA. Margaret Booth-Jones, PhD, Paul Jacobsen, PhD, Laurie LaMonde, MA all from the from the Departments of Interdisciplinary Oncology-Head and Neck Program* and Psychosocial Oncology/Palliative Care, H. Lee Moffitt Cancer Center at University of South Florida College of Medicine, Tampa, FL. The findings were presented before the 5th International Conference on Head and Neck Cancer, being held July 29 through August 2, at the San Francisco Marriott, San Francisco, CA. More than 1,500 leading head and neck surgeons from the United States and 46 nations will gather to hear the latest medical research in the diagnosis, treatment, and reconstruction associated with head and neck cancer. The medical conference is sponsored by the American Head and Neck Society, www.headandneckcancer.org.
The present study is one of the first to report the prevalence of alcohol abuse and dependence based on diagnostic interview in a small cohort of head and neck cancer patients in the United States.
Methodology: A prospective recruitment of patients presenting to either one of two major tertiary care medical centers in Tampa, Florida with stage III or IV squamous cell carcinoma of the head and neck was completed between October 1999 and March 2000. Eligible participants in the study included patients with newly diagnosed or recurrent squamous cell carcinoma whose treatment plan included either surgery alone or in combination with chemotherapy and/or radiotherapy. A minimum of a sixth grade education was required for each. Those excluded were patients with tumor involvement of the central nervous system or for whom English was not their first language.
Eligible patients were identified and recruited by two participating head and neck surgeons. The psychiatric and psychological assessments were completed by masters or Ph.D. level psychology graduate students under supervision and guidance by a neuropsychologist (MBJ) and experienced psychiatrist (MAW). All subjects completed 1) a demographic profile, 2) a Structured Clinical Interview for the DSM-IV Research Version (SCID), and 3) the Mattis Dementia Rating Scale (DRS). Psychiatric and psychological measurements incorporated within the study included: Major Depressive Disorder; Alcohol abuse/dependency; Cognitive Impairment, and Performance Status.
Of thirty-nine eligible patients approached for enrollment, a total of twenty-four agreed to participate and gave informed consent to one of the investigators after thorough explanation of the study goals. Fifteen patients refused to participate Testing was completed within one to two weeks of diagnosis in most cases. There were 20 (83 percent) males and 4 (17 percent), females, and the majority of patients were Caucasian. The mean age of the patients was 73 (age range 49-82). There was little difference between participant and non-participant when the demographic data was compared.
Other characteristics included a similarity of normal activity, symptoms, and tumor size. All participants had stage III or IV head and neck cancer at various sites including oral cavity, oropharynx, hypopharynx and larynx. A total of fourteen patients were either separated, divorced, or widowed for a total of 58.3 percent of patients with a demonstrable loss of a life partner. 33.3 percent of patients were currently married and the remaining 8.3 percent had never been married (one patient was a priest.).
Results: Twenty-three of the twenty-four patients completed the SCID-I-RV. One patient was unable to complete the diagnostic interview and is excluded from this portion of the data analysis. 26.1 percent of patients (N = 6) interviewed met criteria for major depression on initial assessment. Fourteen patients (63.6 percent) met diagnostic criteria for alcohol abuse during their lifetime, and 13 (61.9 percent) met criteria for alcohol dependency during their lifetime.
Five subscales were tested with the Mattis Dementia Rating Scale. All 24 patients completed the cognitive assessment. A total of 15.4 percent of alcohol dependent patients had overall difficulties with initiation and perseveration as well as conceptualization, suggesting problems with frontal lobe executive function. Another 7.7 percent of subjects with alcohol dependency had difficulties with construction, suggesting a non-dominant parietal lobe problem. Two non-dependent alcohol abusers also demonstrated difficulty with conceptualization for a total of 17.4 percent of patients with difficulty in this subscale. These deficits are significant when compared to testing of population norms. Other findings included:
-- A significant correlation between major depression and age where older patients suffered more depression than those in the younger group.
-- Patients were similarly divided into two groups by years of education: group 1 less than 12 years (range 6-12 years, N = 14) and group 2 greater than 13 years (range 13-18 years, N = 10). There was a significant correlation between major depression and years of education where the patients in group 1 suffered more major depression than those in the more highly educated group .
-- There was no significant correlation between major depression and marital status, alcohol use history, or cognitive function. No patient in the study reported a past history of diagnosis or treatment of a psychiatric disorder.
Conclusions: The rate of alcohol abuse and dependence in a head and neck cancer population is greater than 60 percent of a selected group in the present study. In addition, the rate of depression is 26.1 percent, twice that in other studies of various patients with cancers outside the head and neck.
The researchers endorse screening for alcoholism and depression should be completed as part of a thorough evaluation of head and neck cancer patients. Multi-disciplinary teams caring for head and neck patients should include individuals trained to assess patients for symptoms of depression and alcohol dependence or abuse.
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