THE FREQUENCY OF ALCOHOLISM AMONG PATIENTS WITH PAIN DUE TO TERMINAL CANCER

The purpose of this retrospective study was to determine the prevalenc e of alcoholism among terminally ill cancer patients when assessed by multidisciplinary interviews and by the CAGE Questionnaire. We reviewe d the charts of 100 consecutive patients assessed by a multidisciplina ry team for the presence of alcoholism during 1989, and 100 consecutiv e patients assessed by the CAGE Questionnaire during 1992. Alcoholism was diagnosed in 28/100 patients during 1989 (28%) and 18/66 patients during 1992 (27%). Thirty-four patients were unable to complete the GA GE Questionnaire in 1992 because of sedation or cognitive impairment; six of these patients (17%) were found to be alcoholics after multidis ciplinary assessment. Only 9/28 (32%) and 8/24 (33%) patients diagnose d as alcoholics during 1989 and 1992, respectively, had been previousl y diagnosed as alcoholics according to the medical charts. The mean eq uivalent daily dose of morphine during admission and on Day 2 during 1 992 were 153 +/- 193 mg and 183 +/- 198 for alcoholic patients, versus 58 +/- 80 and 70 +/- 79 mg for nonalcoholics (P = 0.06 and 0.03, resp ectively). The maximal dose of opioid and the pain intensity during ad mission however, were not significantly different between alcoholics a nd nonalcoholics. Our results suggest that alcoholism is highly preval ent and underdiagnosed among symptomatic terminally ill cancer patient s The CAGE Questionnaire should be used for screening for alcoholism i n this population. When multidimensional assessment and management of pain is applied, the outcome of alcoholic patients appears to be simil ar to that of nonalcoholics.