A tailored smoking, alcohol, and depression intervention for head and neck cancer patients.
BACKGROUND
Smoking, alcohol use, and depression are interrelated and highly prevalent in patients with head and neck cancer, adversely affecting quality of life and survival. Smoking, alcohol, and depression share common treatments, such as cognitive behavioral therapy and antidepressants. Consequently, we developed and tested a tailored smoking, alcohol, and depression intervention for patients with head and neck cancer.


METHODS
Patients with head and neck cancer with at least one of these disorders were recruited from the University of Michigan and three Veterans Affairs medical centers. Subjects were randomized to usual care or nurse-administered intervention consisting of cognitive behavioral therapy and medications. Data collected included smoking, alcohol use, and depressive symptoms at baseline and at 6 months.


RESULTS
The mean age was 57 years. Most participants were male (84%) and White (90%). About half (52%) were married, 46% had a high school education or less, and 52% were recruited from Veterans Affairs sites. The sample was fairly evenly distributed across three major head and neck cancer sites and over half (61%) had stage III/IV cancers. Significant differences in 6-month smoking cessation rates were noted with 47% quitting in the intervention compared with 31% in usual care (P < 0.05). Alcohol and depression rates improved in both groups, with no significant differences in 6-month depression and alcohol outcomes.


CONCLUSIONS
Treating comorbid smoking, problem drinking, and depression may increase smoking cessation rates above that of usual care and may be more practical than treating these disorders separately.
Duffy
Sonia A
SA
Veterans Affairs Health Services Research and Development Service, Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System 11H, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA. Sonia.Duffy@med.va.gov
Ronis
David L
DL
Valenstein
Marcia
M
Lambert
Michael T
MT
Fowler
Karen E
KE
Gregory
Lynn
L
Bishop
Carol
C
Myers
Larry L
LL
Blow
Frederic C
FC
Terrell
Jeffrey E
JE
D000428:Alcohol Drinking / Q000009:adverse effects* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003863:Depression / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000628:therapy*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome