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A Tailored Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer Patients

¹ Veterans Affairs's Health Services Research and Development Service, Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System; Departments of ² Otolaryngology and ³ Psychiatry, University of Michigan Medical School, ⁴ School of Nursing, University of Michigan, Ann Arbor, Michigan; ⁵ North Texas Veterans Healthcare System; Departments of ⁶ Psychiatry and ⁷ Otolaryngology, University of Texas Southwestern Medical School, Dallas, Texas; and ⁸ Department of Otolaryngology, Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida

Requests for reprints: Sonia A. Duffy, Veterans Affairs Health Services Research and Development Service, Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System (11H), P.O. Box 130170, Ann Arbor, MI 48113-0170. Phone: 734-769-7100 ext. 6210; Fax: 734-761-2939. E-mail: Sonia.Duffy{at}med.va.gov

Background: Smoking, alcohol use, and depression are interrelated and highly prevalent in patients with head and neck cancer, adversely affecting quality of life and survival. Smoking, alcohol, and depression share common treatments, such as cognitive behavioral therapy and antidepressants. Consequently, we developed and tested a tailored smoking, alcohol, and depression intervention for patients with head and neck cancer.

Methods: Patients with head and neck cancer with at least one of these disorders were recruited from the University of Michigan and three Veterans Affairs medical centers. Subjects were randomized to usual care or nurse-administered intervention consisting of cognitive behavioral therapy and medications. Data collected included smoking, alcohol use, and depressive symptoms at baseline and at 6 months.

Results: The mean age was 57 years. Most participants were male (84%) and White (90%). About half (52%) were married, 46% had a high school education or less, and 52% were recruited from Veterans Affairs sites. The sample was fairly evenly distributed across three major head and neck cancer sites and over half (61%) had stage III/IV cancers. Significant differences in 6-month smoking cessation rates were noted with 47% quitting in the intervention compared with 31% in usual care (P < 0.05). Alcohol and depression rates improved in both groups, with no significant differences in 6-month depression and alcohol outcomes.

Conclusion: Treating comorbid smoking, problem drinking, and depression may increase smoking cessation rates above that of usual care and may be more practical than treating these disorders separately. (Cancer Epidemiol Biomarkers Prev 2006;15(11):2203–8)

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