1. Drinking to cope, alcohol and cigarette use, and quality of life in successfully treated HNSCC patients A.K.H. Aarstad  H.J. Aarstad J. Olofsson Department of Surgical Sciences, Faculty of Medicine, University of Bergen, and Department of ENT /Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway

2. QoL following HN cancer treatment Successfully treated HNSCC patients usually report to have fairly good QoL Intuitively there is close connection between amount of treatment and QoL. According to the literature: –Valid throughout treatment. –Valid first year following treatment. –Difficult to show following first year after treatment.

3. QoL following HN cancer treatment If not level of treatment What determines QoL? Psychosocial variables? –Age –Gender –Level of education –Marital status –Children

4. QoL following HN cancer treatment If not level of treatment What determines QoL? Psychosocial variables? –Age –Gender –Level of education –Marital status –Children Mostly not

5. Psychological ”explaining” variables Personality –” Personality represents those characteristics of the person that account for consistent patterns of feeling, thinking and behaving” – (Pervin & John 1996, p.4). Psychological coping

6. Correlation between neuroticism score time point 1 and time point 2 and QoL score time point 2 (N=53) 3.5 years between 1° and 2° time point

7. Quality of life dependent on chosen coping strategy The patients reported to use adequate coping strategies in general QoL associated with: Positive: –Positive re-interpretation Negative –Behavioral/mental disengagement 10-15% common variance To some extent secondary to personality

8. Do Quality of life dependent on level of alcohol and tobacco consumption? Alcohol consumption level is not closely associated with QoL as reported in the literature Smoking level is to some extent associated with QoL as reported in the literature

9. Drinking to cope Concept formed by Carver et al. 1989 Positive answers to questions like “I drink alcohol in order to think less about it”. Associated with dangerous drinking. Associated with mood. Associated with QoL?

10. AIMS To what extent is reported QoL associated with: –reported level of tobacco smoking. –reported level of alcohol consumption. –reported level of drinking to cope.

11. EORTC QoL We have chosen the EORTC (European Organization of Research and Treatment of Cancer) QoL questionnaire

12. EORTC QoL general part (C30) Five functional scales (physical, role, emotional, cognitive and social function), Two symptom scales (fatigue, and nausea/ vomiting). One global health status and one scale on global QoL. Single items with common symptoms (pain, vertigo, sleeping problems, as well as economic influence of disease)

13. EORTC QoL H&N specific part 14 symptom items. 8 items about function.

14. Sample I Patients diagnosed with HNSSC in the period from 1.7.92 – 31.12.97 in Western Norway who had survived the disease Age < 80 years No other newly diagnosed, severe disease N=96

15. Sample II All members of the ”Norwegian Society of Laryngectomized” 105 of 200 (?) patients were included. Anonym response

16. Correlation between drinking to cope, reported alcohol consumption rate, number of cigarettes smoked, utilized general coping style and quality of life (Sample I) Drinking to copeCigarettes per weekAlcohol consumption rate Cigarettes per week.25* Alcohol consumption rate.32**.09 Problem focused coping style.10-.07-.09 Emotion focused coping style.27*.10.03 Avoidance focused coping style.15-.01.09 C30 Global QoL/health-.31**-.14-.21 C30 functional sum score-.34**-.32**-.15 C30 symptom sum score.31**.27*.16 H&N35 sum score.18.11.07 Correlations adjusted by age and gender of the patient

17. Correlation between drinking to cope, reported alcohol consumption rate, number of cigarettes smoked, utilized general coping style and quality of life (Sample I) Drinking to copeCigarettes per weekAlcohol consumption rate Cigarettes per week.25* Alcohol consumption rate.32**.09 Problem focused coping style.10-.07-.09 Emotion focused coping style.27*.10.03 Avoidance focused coping style.15-.01.09 C30 Global QoL/health-.31**-.14-.21 C30 functional sum score-.34**-.32**-.15 C30 symptom sum score.31**.27*.16 H&N35 sum score.18.11.07 Correlations adjusted by age and gender of the patient

18. Correlation between drinking to cope, reported alcohol consumption rate, number of cigarettes smoked, utilized general coping style and quality of life (Sample I) Drinking to copeCigarettes per weekAlcohol consumption rate Cigarettes per week.25* Alcohol consumption rate.32**.09 Problem focused coping style.10-.07-.09 Emotion focused coping style.27*.10.03 Avoidance focused coping style.15-.01.09 C30 Global QoL/health-.31**-.14-.21 C30 functional sum score-.34**-.32**-.15 C30 symptom sum score.31**.27*.16 H&N35 sum score.18.11.07 Correlations adjusted by age and gender of the patient

19. Correlation between drinking to cope, reported alcohol consumption rate, number of cigarettes smoked, utilized general coping style and quality of life (Sample I) Drinking to copeCigarettes per weekAlcohol consumption rate Cigarettes per week.25* Alcohol consumption rate.32**.09 Problem focused coping style.10-.07-.09 Emotion focused coping style.27*.10.03 Avoidance focused coping style.15-.01.09 C30 Global QoL/health-.31**-.14-.21 C30 functional sum score-.34**-.32**-.15 C30 symptom sum score.31**.27*.16 H&N35 sum score.18.11.07 Correlations adjusted by age and gender of the patient

20. Correlation between drinking to cope, reported alcohol consumption rate, number of cigarettes smoked, utilized general coping style and quality of life (Sample I) Drinking to copeCigarettes per weekAlcohol consumption rate Cigarettes per week.25* Alcohol consumption rate.32**.09 Problem focused coping style.10-.07-.09 Emotion focused coping style.27*.10.03 Avoidance focused coping style.15-.01.09 C30 Global QoL/health-.31**-.14-.21 C30 functional sum score-.34**-.32**-.15 C30 symptom sum score.31**.27*.16 H&N35 sum score.18.11.07 Correlations adjusted by age and gender of the patient

21. EORTC C30 functional QoL sum score as dependent variable (with both samples combined) and age, gender, level of neuroticism, coping by behavioral disengagement and DTC as independent variables Un-standardized CoefficientsStandardized Coefficients tSig. BStd. ErrorBeta (Constant) 117.287.1616.380.00 Gender 1.132.86 0.03 0.390.69 Age-0.200.10-0.13-2.070.04 Neuroticism-1.180.26-0.31-4.540.00 Coping by behavioral disengagement -6.181.90-0.22-3.260.00 Drinking to cope-5.031.79-0.19-2.810.01

22. EORTC C30 symptom QoL sum score as dependent variable (with both samples combined) and age, gender, level of neuroticism, coping by behavioral disengagement and DTC as independent variables Un-standardized Coefficients Standardized Coefficients tSig. BStd. ErrorBeta (Constant)-11.507.16-1.610.11 Gender-6.442.86-0.15-2.250.03 Age 0.210.10 0.13 2.150.03 Neuroticism 1.080.26 0.29 4.150.00 Coping by behavioral disengagement 4.071.90 0.15 2.150.03 Drinking to cope 6.171.79 0.24 3.440.00

23. EORTC H&N QoL sum score as dependent variable (with both samples combined) and age, gender, level of neuroticism, coping by behavioral disengagement and DTC as independent variables Un-standardized CoefficientsStandardized Coefficients tSig. BStd. ErrorBeta (Constant) 0.698.06 0.090.93 Gender-9.153.23-0.20-2.840.01 Age 0.200.11 0.12 1.800.07 Neuroticism 0.610.29 0.16 2.090.04 Coping by behavioral disengagement 1.992.13 0.07 0.930.35 Drinking to cope 6.502.02 0.25 3.210.00

24. Similar results regarding association between QoL and DTC were determined if samples I and II were analyzed separately

25. Conclusions Reported QoL was not associated with reported level of alcohol consumption. Reported QoL was to some extent associated with level of tobacco consumption. QoL was inversely associated with DTC level with about 10% common variance.