未确诊的酒精中毒与晚期癌症患者中烟草和非法药物使用的相关性。
Undocumented alcoholism and its correlation with tobacco and illegal drug use in advanced cancer patients.
机构信息
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Cancer. 2011 Oct 1;117(19):4551-6. doi: 10.1002/cncr.26082. Epub 2011 Mar 28.
BACKGROUND
The objectives of this retrospective study were to determine the frequency of undiagnosed alcoholism among patients with advanced cancer who were referred to palliative care and to explore its correlation with alcoholism, tobacco abuse, and use of illegal drugs.
METHODS
The authors reviewed 665 consecutive charts and identified 598 patients (90%) who completed a screening survey that was designed to identify alcoholism, the Cut Down, Annoyed, Guilty, Eye Opener (CAGE) questionnaire, including 100 consecutive patients who had CAGE-positive and CAGE-negative results. Data on tobacco and illegal drug use, the Edmonton Symptom Assessment Scale, and the morphine equivalent daily dose were collected.
RESULTS
The frequency of CAGE-positive results in this palliative care population was 100 of 598 patients (17%). Only 13 of 100 patients (13%) in that CAGE-positive group had been identified as alcoholics before their palliative care consultation. Compared with CAGE-negative patients, CAGE-positive patients were younger (aged 58.6 years vs 61.3 years; P = .07), predominantly men (68 of 100 patients vs 51 of 100 patients; P = .021), more likely to have a history of tobacco use (86 of 100 patients vs 48 of 100 patients; P < .001), more likely to be actively using nicotine (33 of 100 patients vs 9 of 100 patients; P = .02), and more likely to have a history of illegal recreational drug use (17 of 100 patients vs 1 of 100 patients; P < .001). Pain and dyspnea were worse in patients who had a history of nicotine use. Both CAGE-positive patients and patients who had a history of tobacco use more frequently were receiving strong opioids at the time of their palliative care consultation.
CONCLUSIONS
The current findings suggested that alcoholism is highly prevalent and frequently under diagnosed in patients with advanced cancer. CAGE-positive patients were more likely to have a history of, or to actively engage in, smoking and illegal recreational drug use, placing them at risk for inappropriate opioid escalation and abuse.
背景
本回顾性研究的目的是确定在接受姑息治疗的晚期癌症患者中未确诊的酒精中毒的频率，并探讨其与酒精中毒、烟草滥用和非法药物使用的相关性。
方法
作者回顾了 665 例连续病历，并确定了 598 例（90%）完成了旨在识别酒精中毒的筛查调查的患者，包括 100 例 CAGE 阳性和 CAGE 阴性结果的连续患者。收集了烟草和非法药物使用、埃德蒙顿症状评估量表和吗啡等效日剂量的数据。
结果
在这个姑息治疗人群中，CAGE 阳性结果的频率为 598 例患者中的 100 例（17%）。在那个 CAGE 阳性组中，只有 13 例（13%）患者在姑息治疗咨询前被确认为酒精中毒患者。与 CAGE 阴性患者相比，CAGE 阳性患者更年轻（58.6 岁比 61.3 岁；P =.07），主要是男性（68 例比 100 例；P =.021），更有可能有吸烟史（86 例比 100 例；P <.001），更有可能正在使用尼古丁（33 例比 100 例；P =.02），并且更有可能有非法娱乐性药物使用史（17 例比 100 例；P <.001）。有尼古丁使用史的患者疼痛和呼吸困难更严重。在姑息治疗咨询时，CAGE 阳性患者和有吸烟史的患者更频繁地接受强阿片类药物治疗。
结论
目前的研究结果表明，在晚期癌症患者中，酒精中毒的发病率很高，且经常未被诊断。CAGE 阳性患者更有可能有吸烟史或正在吸烟，并且更有可能从事非法娱乐性药物使用，这使他们面临不适当的阿片类药物升级和滥用的风险。
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