title: Alcoholism screening in patients with advanced cancer: impact on symptom burden and opioid use.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Henrique A
authors.initials: HA
authors.lastname: Parsons
authors.forename: Marvin Omar
authors.initials: MO
authors.lastname: Delgado-Guay
authors.forename: Badi
authors.initials: B
authors.lastname: El Osta
authors.forename: Ray
authors.initials: R
authors.lastname: Chacko
authors.forename: Valerie
authors.initials: V
authors.lastname: Poulter
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification* / Q000503:physiopathology; D010166:Palliative Care; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
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