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IIR 98-500 – HSR&D Study

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IIR 98-500
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
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. Karvonen-Gutierrez CA, Ronis DL, Fowler KE, Terrell JE, Gruber SB, Duffy SA. Quality of life scores predict survival among patients with head and neck cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008 Jun 1; 26(16):2754-60.
  2. 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 Mar 1; 48(2):142-8.
  3. 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 & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2006 Nov 1; 15(11):2203-8.
  4. 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 Oct 1; 9(5):1099-105.
  5. 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 Jun 1; 132(6):655-61.
  6. 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 Jan 1; 54(1):150-7.
  7. 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 : official journal of the Society for Research on Nicotine and Tobacco. 2005 Apr 1; 7(2):233-41.
  8. 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 Jun 1; 130(6):764-9.
  9. 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 Apr 1; 130(4):401-8.
  10. 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 May 1; 24(3):140-7.
Conference Presentations

  1. Duffy SA. Tobacco Use, Cessation, and Relapse in Cancer Patients. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 28; Dublin, Ireland.
  2. Duffy SA. Self-efficacy Predicts Enrollment in Smoking Cessation Program for Head and Neck Cancer Patients. Presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland.
  3. Duffy SA. Self-efficacy Predicts Enrollment in Smoking Cessation Program for Head and Neck Cancer Patients. Paper presented at: American Academy of Health Behavior Annual Scientific Meeting; 2009 Mar 8; Hilton Head, SC.
  4. Duffy S. Smoking Cessation, Alcohol, and Depression Intervention. Paper presented at: American Head and Neck Society Research on the Biology, Prevention and Treatment of Head & Neck Cancer Annual Workshop; 2006 Aug 17; Chicago, IL.
  5. Duffy SA. A combined Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer Patients. Paper presented at: Society for Research on Nicotine and Tobacco Annual Conference; 2005 Mar 1; Prague, Czech Republic.
  6. Duffy SA, Terrell JE, Ronis DL, Fowler KE, Valenstein M. Smoking, Alcohol, Depression and Quality of Life in Head and Neck Cancer. Paper presented at: International Congress of Behavioral Medicine; 2004 Aug 1; Mainz, Germany.
  7. Fowler KE, Taylor JC, Terrell JE, Ronis DL, Duffy SA. Disability in Head and Neck Cancer Patients. Paper presented at: International Congress of Behavioral Medicine; 2004 Aug 1; Mainz, Germany.
  8. Duffy SA, Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB. Clinical Predictors of Quality of Life in Head and Neck Cancer Patients. Paper presented at: National Cancer Institute Specialized Program of Research Excellence Investigators Annual Workshop; 2004 Jul 1; Baltimore, MD.
  9. Duffy SA, Terrell JE. A Combined Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer Patients. Paper presented at: University of Michigan Department of Otolaryngology Head and Neck Annual Retreat; 2002 May 13; Ann Arbor, MI.
  10. Duffy SA, Terrell JE. A Combined Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer Patients. Paper presented at: Oncology Nursing Society Annual Congress; 2002 Apr 19; Washington, DC.
  11. Duffy SA, Terrell JE. A Combined Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer Patients. Paper presented at: American Academy of Health Behavior Annual Scientific Meeting; 2002 Mar 25; Napa Valley, CA.
  12. Duffy SA, Terrell JE. Association Between Smoking, Alcohol, Depression, and Quality of Life in Head and Neck Cancer. Paper presented at: Society for Research on Nicotine and Tobacco Annual Conference; 2002 Feb 20; Savannah, GA.
  13. Duffy SA, Terrell JE. Association Between Smoking, Alcohol, Depression, and Quality of Life in Head and Neck Cancer. Paper presented at: International Society for Quality of Life Research Annual Meeting; 2001 Oct 30; Ann Arbor, MI.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: Epidemiology, Treatment - Observational
Keywords: Cancer, Comorbidity, Patient outcomes
MeSH Terms: none

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