S Duffy, VA Ann Arbor Health Care System; J Terrell, University of Michigan and VA Ann Arbor Health Care System; M Valenstein, University of Michigan and VA Ann Arbor Health Care System; D Ronis, University of Michigan and VA Ann Arbor Health Care System; C Kilarski, VA Ann Arbor Health Care System; M Connors, VA Ann Arbor Health Care System

Objectives: Head/neck cancer (HN CA) patients are at increased risk for smoking, alcohol intake, depression, and poor quality of life (QoL), and these behaviors/disorders are often interrelated. Research has shown that despite their past history, HN Ca patients who screen negative for smoking, alcohol intake, and depression have greater rates of survival. The specific aims of this study were to:

1. determine baseline levels of smoking, alcohol intake, depression and QoL in H/N Ca patients;

2. determine whether H/N Ca patients would be interested in interventions for smoking, alcohol intake and depression; and

3. determine if there is a relationship between smoking, alcohol intake and depression and the QoL of H/N Ca patients.

Methods: A research assistant distributed a self-administered questionnaire on smoking, alcohol, depression and QoL to HN Ca patients (N=105) while they are in the waiting to be seen for their scheduled ENT appointment at a VA (n=77) and University Hospital (n=28). Smoking, alcohol intake, depression and QoL were be measured by previously validated instruments including the Fagerstrom Test for Nicotine Dependence (FTND), Alcohol Use Disorder Identification Test (AUDIT), the Geriatric Depression Scale (GDS), the SF36V, and HNQoL instrument. Descriptive statistics were calculated on smoking, alcohol intake, depression, QoL, and interest in receiving related services. T-tests and linear regressions were calculated to determine the influence of smoking, drinking alcohol and depression on QoL scores.

Results: Of the 105 respondents, 35% smoked, 43% drank alcohol, and 63% had a positive score for clinical depression. Seventy-nine percent scored positive for one or more of these behaviors/disorders, 41% scored positive for two or more of these behaviors/disorders, and 20% scored positive for all three of these behaviors/disorders. Thirty-one percent (n=32) of the subjects who smoked were interested in smoking cessation services, 8% (n=37) who drank alcohol were interested in related services, and 31% (n=55) of those depressed were interested in depression services.

Smokers, alcohol drinkers and depressed HN Ca patients had significantly decreased SF36V and HNQoL scores with depression having the greatest impact on decreased QoL. Depression (P< 0.0285) was a significant predictor of a decreased SF36V physical component QoL score. Depression (P< 0.0005) and nicotine dependence (P< 0.0165) were significant predictors of a decreased SF36V mental health component score. Depression (P <0.0004) and alcohol dependence (P< 0.0177) were significant predicators of a decreased HNQoL emotional score.

Conclusions: HN Ca patients remain at a higher risk than the general population for smoking, alcohol intake, and depression, the very risk factors that contributed to their disease. Approximately one-third of all smokers and depressed HN Ca patients were interested in treatment, however, few of those who drank alcohol were interested in treatment. HN Ca patients who continue to smoke, drink alcohol and are depressed have significantly lower QoL scores than those who do not have these behaviors/disorders.

Impact: The data suggests that current intervention strategies for these behaviors/disorders are not impacting a significant number of HN Ca patients. Aggressive intervention strategies are needed for HN Ca patients who smoke, drink alcohol and are depressed.