A Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer
Sonia A. Duffy PhD MS RN
VA Ann Arbor Healthcare System
Ann Arbor, MI
Funding Period: October 2000 - March 2004

BACKGROUND/RATIONALE:
Data from the Surveillance, Epidemiology and End Results (SEER) cancer registry indicates that head and neck cancers (HN Ca) are nearly twice as common in veterans as non-veterans. HN Ca patients are at an increased risk for smoking, alcohol consumption and depression, all of which contribute to a further decline in their quality of life (QoL). In the HN Ca population, diagnosis and treatment of smoking, alcohol intake and depression are sub-optimal, thereby affecting QoL and survival. Numerous studies have documented that smoking, alcohol and depression are interrelated and research on multi-modal interventions has been suggested.

OBJECTIVE(S):
To determine whether a combined intervention for smoking, alcohol intake, and depression improves the QoL of veterans with HN Ca.

METHODS:
Patients from three VA medical centers (Ann Arbor, MI; Dallas, TX; Gainesville, FL) who have at least one of the three disorders of smoking, drinking and depression were randomized to either usual care or the combined intervention. Data was collected on smoking, alcohol consumption, depression and QoL at baseline, 6- and 12- months after the intervention (or non-intervention). The main analyses consisted of analysis of covariance (ANCOVA) to compare the scores on the SF-36 mental health scores and on the emotional domain of Head and Neck Quality of Life Questionnaire between the experimental and control group at 6- and 12- month follow up. Additional analyses examineded smoking, alcohol intake, and depression scores at these same time points.

FINDINGS/RESULTS:
Of the 154 patients that returned 6-month surveys, preliminary results show that those in the intervention had marginally significantly better QoL mental health scores (mean 67) than those receiving usual care (mean 59) (p<.06). Using an intention to treat analysis, there were no differences in depression and alcohol use between intervention and control subjects. However, there was a significant difference (p<.05) in smoking with 47% (35 out of 74) quitting in the intervention group compared to 31% (19 out of 62) quitting in the usual care group.

IMPACT:
Since smoking, alcohol use, and depression are interrelated and respond to common treatment techniques (e.g., CBT), treatment of these behaviors/disorders in combination may be more successful and practical than treating separately.

PUBLICATIONS:

Journal Articles

1. Duffy SA, Ronis DL, Valenstein M, Fowler KE, Lambert MT, Bishop C, Terrell JE. Depressive symptoms, smoking, drinking, and quality of life among head and neck cancer patients. Psychosomatics. 2007; 48(2): 142-8.
2. Duffy SA, Ronis DL, Valenstein M, Lambert MT, Fowler KE, Gregory L, Bishop C, Myers LL, Blow FC, Terrell JE. A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiology, Biomarkers and Prevention. 2006; 15(11): 2203-8.
3. Duffy SA, Ronis D, Fowler K, Schim SM, Jackson FC. Differences in veterans' and nonveterans' end-of-life preferences: a pilot study. Journal of Palliative Medicine. 2006; 9(5): 1099-105.
4. Cheng SS, Terrell JE, Bradford CR, Ronis DL, Fowler KE, Prince ME, Teknos TN, Wolf GT, Duffy SA. Variables associated with feeding tube placement in head and neck cancer. Archives of Otolaryngology -- Head & Neck Surgery. 2006; 132(6): 655-61.
5. Duffy SA, Jackson FC, Schim SM, Ronis DL, Fowler KE. Racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care. Journal of The American Geriatrics Society. 2006; 54(1): 150-7.
6. Lambert MT, Terrell JE, Copeland LA, Ronis DL, Duffy SA. Cigarettes, alcohol, and depression: characterizing head and neck cancer survivors in two systems of care. Nicotine & Tobacco Research. 2005; 7(2): 233-41.
7. Taylor JC, Terrell JE, Ronis DL, Fowler KE, Bishop C, Lambert MT, Myers LL, Duffy SA, Bradford CR, Chepeha DB, Hogikyan ND, Prince ME, Teknos TN, Wolf GT. Disability in patients with head and neck cancer. Archives of Otolaryngology -- Head & Neck Surgery. 2004; 130(6): 764-9.
8. Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB, Prince ME, Teknos TN, Wolf GT, Duffy SA. Clinical predictors of quality of life in patients with head and neck cancer. Archives of Otolaryngology -- Head & Neck Surgery. 2004; 130(4): 401-8.
9. Duffy SA, Terrell JE, Valenstein M, Ronis DL, Copeland LA, Connors M. Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. General Hospital Psychiatry. 2002; 24(3): 140-7.

DRA: Mental Illness, Substance Abuse, Addictive Disorders
DRE: Epidemiology, Resource Use and Cost, Treatment
Keywords: Cancer, Comorbidity, Patient outcomes
MeSH Terms: none