Moussas G I, Papadopoulou A G
Department of Psychiatry, "Sotiria" General Hospital for Chest Diseases, Athens.
2nd Department of Psychiatry, "Attikon'' General Hospital, Athens University Medical School, Athens, Greece.
Psychiatriki. 2017 Jul-Sep;28(3):234-241. doi: 10.22365/jpsych.2017.283.234.
Substance abuse is a health problem with serious psychological and psychiatric dimensions and multiple social and economic consequences. Cancer is a disease that threatens not only life and physical integrity but mental health as well. Oncology patients suffer from mental disorders in high rates, especially from depression and anxiety. The role of substance abuse in the pathogenesis of cancer is studied systematically, since there are research data supporting the mutagenic effects of certain substances. It has been supported that a possible dysregulation of the immune system is linked to the oncogenic processes induced by substances of abuse. Specifically, opioids are the first addictive substances that have been identified as oncogenic factors. However, conflicting results have been offered by experimental animal studies, which showed that opioids, such as morphine, depending on the dosage administered, may not only enhance the process of tumor growth, but also inhibit it. Additionally, research data indicate that the use of cannabis may be associated with cancer, either as an independent factor or in relation to other mutagenics, although it is not yet clear to which extent these effects may be connected to the disease, especially once the consumption of tobacco and alcohol by these patients are taken into account. However, it has been argued that certain cannabinoids may have biological -anticancer- activities which could be used therapeutically without being accompanied by the corresponding 9-tetrahydrocannabinol psychoactive effects. It is well known that alcohol is a risk factor for developing head and neck cancer, and epidemiological studies indicate that the higher the consumption of alcohol, the more mortality due to cancer increases. In addition, it is suggested that there is no safety level for alcohol consumption regarding the risk of developing cancer; that is even a minimum daily consumption is associated with the occurrence of certain types of cancer. Specific components have been identified in tobacco, which are considered to be carcinogenic and responsible for tumor development in various sites. Moreover, complicated psychiatric problems arise due to substance abuse in cancer patients, either in the context of pain treatment, or under pre-existing dependence. The rational use of opioid analgesics, when it is medically required as suggested by the health professionals specialized in the treatment of acute pain in cancer patients, could be a therapeutic option. Substance abuse reduces treatment compliance, worsens cancer prognosis and seems to be a negative factor for the quality of life of these patients. Current literature highlights the importance of appropriate psychiatric interventions to address substance abuse in cancer patients.
药物滥用是一个涉及严重心理和精神层面以及多种社会和经济后果的健康问题。癌症是一种不仅威胁生命和身体完整性，还会影响心理健康的疾病。肿瘤患者中精神障碍的发生率很高，尤其是抑郁症和焦虑症。由于有研究数据支持某些物质的诱变作用，因此对药物滥用在癌症发病机制中的作用进行了系统研究。有人认为，免疫系统可能的失调与药物滥用所引发的致癌过程有关。具体而言，阿片类药物是首批被确定为致癌因素的成瘾性物质。然而，实验动物研究得出了相互矛盾的结果，这些研究表明，吗啡等阿片类药物，根据给药剂量的不同，不仅可能促进肿瘤生长过程，还可能抑制肿瘤生长。此外，研究数据表明，使用大麻可能与癌症有关，要么作为一个独立因素，要么与其他诱变剂有关，尽管目前尚不清楚这些影响与该疾病的关联程度，尤其是考虑到这些患者同时吸烟和饮酒的情况。然而，有人认为某些大麻素可能具有生物抗癌活性，可用于治疗，且不会产生相应的9-四氢大麻酚精神活性作用。众所周知，酒精是头颈癌的一个风险因素，流行病学研究表明，酒精消费量越高，癌症死亡率上升得越多。此外，有人认为，就患癌风险而言，不存在安全的酒精消费水平；也就是说，即使是最低的每日消费量也与某些类型癌症的发生有关。烟草中已鉴定出特定成分，这些成分被认为具有致癌性，并导致不同部位的肿瘤发展。此外，癌症患者因药物滥用会出现复杂的精神问题，无论是在疼痛治疗过程中，还是在已有的依赖情况下。当癌症患者急性疼痛治疗方面的专业健康专家建议出于医疗需要时，合理使用阿片类镇痛药可能是一种治疗选择。药物滥用会降低治疗依从性，恶化癌症预后，似乎是这些患者生活质量的一个负面因素。当前文献强调了适当的精神干预对解决癌症患者药物滥用问题的重要性。
