Nokovitch Lara, Kim Yonjae, Zrounba Philippe, Roux Pierre-Eric, Poupart Marc, Giagnorio Rabiha, Triviaux Dominique, Maquet Charles, Thollin Jennifer, Arantes Nathalie, Thomas Nathalie, Fervers Béatrice, Deneuve Sophie
Surgical Oncology Department, Centre Léon Bérard, UNICANCER, 69008 Lyon, France.
Medical Oncology Department, Centre Léon Bérard, UNICANCER, 69008 Lyon, France.
Cancers (Basel). 2023 Feb 15;15(4):1231. doi: 10.3390/cancers15041231.
To evaluate the evolution of addictions (tobacco and alcohol) and social precarity in head and neck squamous cell carcinoma survivors when these factors are addressed from the time of diagnosis.
Addictions and social precarity in patients with a new diagnosis of HNSCC were assessed through the EPICES score, the Fagerström score, and the CAGE questionnaire. When identified as precarious/dependent, patients were referred to relevant addiction/social services.
One hundred and eighty-two patients were included. At the time of diagnosis, an active tobacco consumption was associated with alcohol drinking (Fisher's exact test, < 0.001). Active smokers were more socially deprived (mean EPICES score = mES = 36.2 [±22.1]) than former smokers (mES = 22.8 [±17.8]) and never smokers (mES = 18.9 [±14.5]; Kruskal-Wallis, < 0.001). The EPICES score was correlated to the Fagerström score (Kruskal-Wallis, < 0.001). Active drinkers (mES = 34.1 [±21.9]) and former drinkers (mES = 32.7 [±21]) were more likely to be socially deprived than those who never drank (mES = 20.8 [±17.1]; Krukal-Wallis, < 0.001). A Fagerström score improvement at one year was associated to a CAGE score improvement (Fisher's exact test, < 0.001). Tobacco and alcohol consumption were more than halved one year after treatment. Patients who continued to smoke one year after diagnosis were significantly more likely to continue to drink (Fisher's exact test, < 0.001) and had a significantly higher initial EPICES score (Kruskal-Wallis, < 0.001).
At one year, addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent patients and those with multiple frailties are at highest risk of cessation failure.
评估从诊断时就关注这些因素的情况下，头颈部鳞状细胞癌幸存者的成瘾情况（烟草和酒精）及社会不稳定状况的演变。
通过EPICES评分、Fagerström评分和CAGE问卷评估新诊断为头颈部鳞状细胞癌患者的成瘾情况及社会不稳定状况。当确定患者处于不稳定/依赖状态时，将其转介至相关的成瘾/社会服务机构。
纳入182例患者。诊断时，当前吸烟与饮酒相关（Fisher精确检验，<0.001）。当前吸烟者比既往吸烟者（平均EPICES评分为22.8[±17.8]）和从不吸烟者（平均EPICES评分为18.9[±14.5]）在社会经济方面更匮乏（Kruskal-Wallis检验，<0.001）。EPICES评分与Fagerström评分相关（Kruskal-Wallis检验，<0.001）。当前饮酒者（平均EPICES评分为34.1[±21.9]）和既往饮酒者（平均EPICES评分为32.7[±21]）比从不饮酒者在社会经济方面更匮乏（Kruskal-Wallis检验，<0.001）。一年时Fagerström评分的改善与CAGE评分的改善相关（Fisher精确检验，<0.001）。治疗一年后，烟草和酒精消费量减少一半以上。诊断后一年仍继续吸烟的患者更有可能继续饮酒（Fisher精确检验，<0.001），且初始EPICES评分显著更高（Kruskal-Wallis检验，<0.001）。
一年时，若从诊断时就加以关注，成瘾情况和社会经济匮乏状况往往会有所改善。依赖性最强的患者和存在多种脆弱因素的患者戒烟失败的风险最高。
