Association between alcoholism and symptom expression, patient symptom goals, and clinical response in advanced cancer patients

  • Sebastiano MercadanteEmail author
  • Claudio Adile
  • Patrizia Ferrera
  • Alessandra Casuccio
Original Article



The aim of this study was to determine the influence of alcoholism on symptom expression, personalized symptom goal (PSG) and patient goal response (PGR), and patient global impression (PGI) in advanced cancer patients.


This was a secondary analysis of an international multicenter study. Advanced cancer patients who had a history of alcohol dependence positive, according to CAGE (cut down, annoy, guilt, eye-opener), were selected. Thirty patients (3.45%) were CAGE-positive. This sample was matched with 30 patients with similar characteristics who were CAGE-negative. Patients rated symptom intensity by using the Edmonton Symptom Assessment Score (ESAS) at admission (T0) and then after 1 week. For each symptom, patients reported their PSG. After a week of comprehensive palliative care, PSG was measured again (T7), as well as the achievement of PGR, and PGI. Minimal clinically important difference (MCID) was calculated by PGI of improvement or deterioration at T7 (bit better or a little worse, respectively).


A significant decrease in intensity was found for most symptoms in both groups. In CAGE-negative and CAGE-positive patients, most patients had a PSG of ≤ 3 for all ESAS items as a target at T0. All PSG targets did not changed significantly after 1 week of palliative care in both groups. Although CAGE-positive basically had unfavorable PGI and PGR, a statistical significance was achieved only for appetite (P = 0.037; ANOVA test). In CAGE-negative patients, Karnofsky was the only factor independently associated with PGI for pain and dyspnea. Factors independently associated with PGI for nausea were symptom intensity at T0 and home situation. In CAGE-positive patients, Karnofsky was independently associated with PGI for pain, nausea, and well-being. Symptom intensity at T0 was independently associated with PGI for weakness.


CAGE-positive advanced cancer patients favorably responded to a palliative care intervention. No greater differences have been found in comparison with CAGE-negative patients for PSG, PGR, and PGI, except for appetite. Further studies with large number of patients could confirm some trends observed in this study.


Advanced cancer patients Symptom burden Alcoholism Patients’ goals Global impression Clinical response 


Compliance with ethical standards

Local institutional review boards at all participating centers approved the protocol, and written informed consent was obtained from all patients.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    • 2
    Email author
  • Claudio Adile
    • 1
  • Patrizia Ferrera
    • 1
  • Alessandra Casuccio
    • 3
  1. 1.Main Regional Center for Pain Relief and Supportive-Palliative Care UnitLa Maddalena Cancer CenterPalermoItaly
  2. 2.Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care UnitLa Maddalena Cancer CenterPalermoItaly
  3. 3.Department of Sciences for Health Promotion and Mother Child CareUniversity of PalermoPalermoItaly

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