title: The frequency of alcoholism in patients with advanced cancer admitted to an acute palliative care unit and a home care program.
abstract: BACKGROUND
  Cancer patients with a history of alcoholism may be problematic. The frequency of alcoholism among patients with advanced cancer has never been reported in Italy or other European countries.
  
  
  OBJECTIVE
  The aim of this prospective study was to determine the frequency of alcoholism, assessed with a simple and validated instrument, among patients with advanced cancer who were referred to two different palliative care settings: an acute inpatient palliative care unit (PCU) of a comprehensive cancer center in a metropolitan area and a home care program (HCP) in a territorial district, localized in the mountains of Italy.
  
  
  METHODS
  A consecutive sample of patients admitted to an inpatient PCU and to an HCP was assessed for a period of eight months. Each patient who agreed to be interviewed completed the Cut down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire. Patients were then interviewed informally to gather information about their history with alcohol.
  
  
  RESULTS
  In total, 443 consecutive patients were surveyed; data from 249 to 194 patients were collected in the PCU and HCP, respectively, in the eight-month period. The mean age was 66.4 (SD 12.7) years, and 207 were males. The mean Karnofsky level was 54.2 (SD 14.6). Eighteen patients were CAGE positive (4.06%). Males (Pearson Chi-squared, P = 0.027) and younger patients (analysis of variance test, P = 0.009) were more likely to be CAGE positive. Informal interviews revealed that 17 patients (3.83%) were alcoholics or had a history of alcoholism, and that alcoholism was strongly correlated with CAGE (Pearson Chi-squared, P < 0.0001).
  
  
  CONCLUSIONS
  Only a minority of patients were CAGE positive, with a similar frequency in the PCU and HCP settings. CAGE-positive patients were more likely to be male and younger, independent of diagnosis and performance status. CAGE was positively correlated with informal interviews for detecting alcoholism. As CAGE patients express more symptom distress, it is important to detect this problem with a simple tool that has a high sensitivity and specificity and is easy to use even in patients with advanced disease.
authors: Anesthesia & Intensive Care Unit and Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy. Electronic address: 03sebelle@gmail.com.
authors: Sebastiano
authors: S
authors: Mercadante
authors: Home Care Program, L'Aquila per la Vita, Department of Oncology, University of L'Aquila, L'Aquila, Italy.
authors: Giampiero
authors: G
authors: Porzio
authors: Home Care Program, SAMO, Palermo, Italy.
authors: Amanda
authors: A
authors: Caruselli
authors: Home Care Program, L'Aquila per la Vita, Department of Oncology, University of L'Aquila, L'Aquila, Italy.
authors: Federica
authors: F
authors: Aielli
authors: Anesthesia & Intensive Care Unit and Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
authors: Claudio
authors: C
authors: Adile
authors: Home Care Program, SAMO, Palermo, Italy.
authors: Nicola
authors: N
authors: Girelli
authors: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
authors: Alessandra
authors: A
authors: Casuccio
mesh_terms: D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002173:Cancer Care Facilities; D005260:Female; D006699:Home Care Services; D006801:Humans; D007407:Interviews as Topic; D007558:Italy / Q000453:epidemiology; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D010166:Palliative Care; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires
keywords: Alcoholism; CAGE; advanced cancer patients; palliative care