Alcohol consumption after laryngectomy

Alcohol consumption after laryngectomy

Danker, H.,* Keszte, J.,* Singer, S.,* Thoma, J.,† Taschner, R.,‡ Brahler, E.* & Dietz, A.‡

*Department of Medical Psychology and Medical Sociology, University of Leipzig, �Medica Clinic for Outpatient

Rehabilitation and Sports Medicine, and �Department of Otolaryngology Head and Neck Surgery, University of

Leipzig, Leipzig, Germany

Accepted for publication 16 May 2011

Clin. Otolaryngol. 2011, 36, 336–344

Objective: The aim of the study was the analysis of

drinking behaviour in laryngectomised patients and its

concomitants in quality of life and mental health.

Study design: Multi-centered cross-sectional study.

Participants and setting: Two hundred and twenty-five

laryngectomised patients were asked to participate in the

study. One hundred and seventy nine patients (80%)

were interviewed after laryngectomy at six different ENT

clinics in Germany.

Main outcome measures: ‘Questionnaire of Health

Behaviour’ (FEG), ‘Short Questionnaire of Alcohol Risk’,

Hospital Anxiety and Depression Scale (HADS), Hornhe-

ider Questionnaire (HFB), Visual Analogue Scales (VAS)

and the Quality of Life Questionnaires of the European

Organization of Research and Treatment of Cancer (EO-

RTC) (EORTC QLQ-C30, EORTC QLQ-H & N35).

Results: Alcohol dependence was found in 7% of the

patients. Half of the respondents showed a constant con-

sumption of alcohol with 6% of the patients who wanted

to change their consumption. Patients with alcohol

dependence indicated in comparison with non-dependent

persons increased anxiety (p = 0.03), problems in coping

with illness (p = 0.03), increased psychosocial care needs

(p = 0.02), fatigue (p = 0.04), shortness of breath

(p = 0.04), diarrhoea (p = 0.02) and a worse emotional

functioning level (p = 0.03). Alcohol intake was indepen-

dent of tumour stage (p = 0.48), employment status

(p = 0.54), social class (p = 0.82), the time interval since

laryngectomy (p = 0.64) and type of voice substitute

(p = 0.76). The quality of life and mental state were

independent of the amount of alcohol consumed.

Conclusions: The results show that alcohol dependence

is associated with adverse psychosocial and medical con-

sequences, which require treatment. Socio-demographic

and medical parameters do not allow any conclusions to

alcoholism risk. Therefore, an individual exploration of

the patients’ drinking behaviour is needed, which could

prepare the ground to specific treatment.

Premorbid and post-treatment alcohol consumption

as a risk factor

Epidemiological research has been dealing with the ques-

tion of the influence of smoking and drinking habits on

the emergence of laryngeal cancer for a long time. So far,

this research has focused primarily on the extent to which

the risk of contracting cancer is changed both through

risk factors’ independent effects as well as through their

combined effects.

Today, all agree that drinking alcohol increases the

probability of contracting cancer in the head and neck

area.1–5

Although there is extensive literature demonstrating a

wide range of harmful effects, alcohol has on health,

much less is known about how continuing to drink post-

treatment affects patients with head and neck cancer.6 It

is assumed that the probability of local recurrence or of a

second carcinoma emerging increases.7,8

Postoperative alcohol consumption behaviour

Despite the known association between alcohol use and

the development of head and neck cancer, the prevalence

of alcohol abuse and dependency in this patient popula-

tion is rarely reported. This is particularly true of patients

who have undergone laryngectomies. The few studies that

do exist on the subject report widely varying prevalence

values. The same is true for psycho-social concomitants

of alcohol abuse after cancer treatment. The degree to

which alcohol interfaces with mental distress and quality

of life in former laryngectomy patients has not been

Correspondence: Helge Danker, Department of Medical Psychology and

Medical Sociology, University of Leipzig, Philipp-Rosenthal-Straße 55,

04103 Leipzig, Germany. Tel.: 0049341 ⁄ 9715407; Fax: 0049341/9715419;

e-mail: [email protected]

OR

IG

IN

AL

AR

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CL

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336 � 2011 Blackwell Publishing Ltd • Clinical Otolaryngology 36, 336–344

examined sufficiently. Figures on the number of patients

who consume alcohol after undergoing a laryngectomy

range from 34 to 88 percent.9–13

Furthermore, up to seven per cent of laryngectomy

patients have been seen to significantly increase their

alcohol intake post-operation.10,14

Compared with the general population, in which 3% of

men and 1% of women are dependent on alcohol,15 the

men in these studies who had had a laryngectomy were

more than twice as likely to be alcoholic.

Not only are men more likely than women to drink

alcohol,16,17 connections between tumour stage and

alcohol consumption have also been found. Patients with

stage 1 cancer for instance are more likely to drink

alcohol than are patients with cancer in stages two to

four. Patients were far more likely to drink alcohol if

their surgery lay more than a year in the past. In contrast,

patients drank much less if they had received treatment

in the preceding year.16

Psychosocial aspects of postoperative alcohol

consumption

The psychosocial consequences of postoperative alcohol

consumption in laryngectomy patients have been previ-

ously studied in mixed samples of various patients with

head and neck tumour with sometimes contradictory

results. These studies showed that there are no significant

connections between depression and alcohol consumption

or alcohol dependency in patients with head and neck

tumours.12,18 One study found non-drinker’ quality of life

to be higher than that of alcoholics.12 A further study

concluded that patients with head and neck tumour who

abuse alcohol are 29 times more likely to have a lower

quality of life.19 In contrast, another study found no

connection between alcohol consumption and quality

of life.18

The prevalence data on postoperative alcohol con-

sumption after laryngectomy vary considerably between

studies. There is also little known about the interaction

of socio-demographic, clinical, psycho-social factors and

quality of life in this population. The studies that do

exist on the subject have produced contradictory results.

These observations lead to the following research

questions:

1 How pronounced is postoperative alcohol consumption

currently in laryngectomy patients?

2 Are these patients motivated to change their drinking

habits?

3 What connections are there between laryngectomy

patients’ alcohol consumption, mental state, and quality

of life?

Methods

Study design

This was a multi-centered cross-sectional study. Patients

were recruited at the University of Leipzig, the St.

Georg Hospital in Leipzig, the Chemnitz Clinic, the

Dresden-Friedrichstadt Hospital, Martin-Luther-Univer-

sity of Halle-Wittenberg and the Martha-Maria Hospital

in Halle-Dolau. Data were through face-to-face struc-

tured interviews conducted between the years of 2005

and 2006.

Conducting the study

All surviving patients (according to clinic records) who

had had tumour-related laryngectomies at the participat-

ing institutions were solicited. They were informed of the

study and given a suggested time for an interview. The

survey was conducted after obtaining patient permission.

Structured interviews were conducted by professional psy-

chologists and trained psychology and medical students

in participating patients’ homes. Participants also filled

out various questionnaires on their own. It was not

explicitly stated in the invitation letter that participants

would be asked to disclose their alcohol consumption

during the interview.

Study instruments

Questionnaire to determine health-related behaviour (FEG

in German). The Questionnaire to Determine Health-

related Behaviour is a self-evaluation process that

addresses health-related behaviour patterns, attitudes, and

other health-relevant aspects.20 We used items from the

alcohol-scale for this study.

The interview focused on four categories of alcohol

intake (beer, wine ⁄ champagne, spirits, and other alcoholic

drinks), frequency of consumption (daily, several times a

week, seldom, never), and amount of ethanol consumed

per month in grams (abbreviated with g ⁄ m later).

The German Center for Addiction Matters15 has, over

the past few years, defined different consumption classes

to estimate the level of risk any given individual is at of

developing alcoholism, and of suffering or causing

alcohol-related mental or social damage. Men, for

instance, who consume less than 900 g ⁄ m of pure alcohol

a month fall into the low risk category. The term low risk

is used intentionally to indicate that alcohol consumption

is never entirely risk-free. Risky consumption is defined

as drinking between 900 and 1800 g ⁄ m a month, and

Alcohol consumption after laryngectomy 337

� 2011 Blackwell Publishing Ltd • Clinical Otolaryngology 36, 336–344

drinking more than 1800 g ⁄ m of pure alcohol a month is

considered a dangerous level of consumption.

Participants’ motivation to change their alcohol con-

sumption was determined with an open question: ‘Would

you like to change your alcohol consumption?’

Short questionnaire for those vulnerable to alcohol. The

short questionnaire for those vulnerable to alcohol is a

screening instrument used to determine alcohol depen-

dency. It contains 22 items in four subscales to be

answered with either yes or no: Somatic Area (hands

trembling, morning nausea, tremors and nausea relieved

by alcohol, decreased tolerance), Mental Area (nervous-

ness, reduced appetite, sleep disturbances, nightmares,

memory loss, remorse, less efficient at work), Social Area

(occupation associated with alcohol consumption, con-

flicts with colleagues, lots of friends drink, financial

problems because of drinking, drunk-driving), Depen-

dent Drinking (feeling tense and restless without alcohol,

urge to drink more, failed attempts to control drinking,

drinking in solitude, greater feeling of self-confidence

with alcohol, hiding stored alcohol, stress-induced drink-

ing). Scores are reached by totalling the number of posi-

tive answers. People who score six or more points are

very likely to be dependent on alcohol. In the following

material, we designate such values as ‘alcohol depen-

dency’. Men as well as women show a high correlation

with the outer criterion of the clinical diagnosis of

r = 0.81 for men and r = 0.85 for women.21

A potential criticism of these criteria, however, might

be that the diagnostic symptoms and disorders are mixed

together and may be incomplete (as compared with

DSM-IV and ICD-10). Whatever disadvantages this ques-

tionnaire has, however, have to be weighed against the

important fact that it is very efficient for everyday use in

the clinic and in research studies.

Hospital Anxiety and Depression Scale (HADS). The

HADS is a self-evaluation questionnaire used in somatic

medicine to determine patients’ tendencies toward anxiety

and depression.22

It has two subscales each comprised of seven items that

are presented in alternating sequence. One total score is

created from the individual subscales. The clinical evalua-

tion was performed with cut-off values. We distinguished

between unnoticeable (<8), borderline (8–11) and notice-

able characteristics (>11).

Hornheider questionnaire (HFB). The HFB was developed

to identify patients in need of psycho-oncological help.23

The short form we used contained the nine items from

the longer form that provide the greatest distinctions.

A patient is considered in need of help if their total score

is greater than 15, or if individual critical item values

have been exceeded.

Visual analogue scale (VAS). Visual analogue scales were

used in the study to determine participants’ physical state

of being and their level of skill for coping with illness.24

Quality of life (EORTC QLQ-C30 and EORTC QLQ-

H&N35). Two quality of life questionnaires from the

European Organization of Research and Treatment of

Cancer (EORTC) were used: the ‘Quality of Life Core

Questionnaire’ (EORTC QLQ-C30) and the ‘Head and

Neck Module’ (EORTC QLQ-H&N35). These question-

naires are validated by internationally recognised instru-

ments for measuring health-related quality of life of the

patients with cancer.25,26

The core model QLQ-C30 uses 30 questions to evalu-

ate general quality of life on patients with cancer. This

contains functionality scales measuring mental, emo-

tional, cognitive and social functioning, role functions,

and global quality of life, as well as various general symp-

tom scales. In the QLQ-H&N35, there are 35 questions

on quality of life focused on the head and neck area.

Among the issues covered are as follows: pain in the

mouth and throat area, problems swallowing, smelling,

tasting and speaking, problems in relationships and sexu-

ality, problems in eating, problems with teeth or opening

the mouth, and problems with dry mouth, thick saliva,

coughing, and feeling sick. The raw data were summar-

ised and transformed according to the EORTC’s manual.

On the functionality scales, high values indicate a better

quality of life, and on the symptoms scales high values

represent a lower quality of life.

Statistical data analysis

A descriptive statistics was drawn up (mean standard

deviation) for the variable ‘alcohol consumption’. We also

used Mann and Withney’s analysis of variance (anova)

U-Test to calculate mean differences in postoperative

alcohol consumption between tumour stages, social

classes, and occupations. The mean differences between

alcoholics and non-alcoholics with respect to all other

psychosocial variables were also performed using Mann

and Withney’s U-tests. The statistical data analysis was

performed using spss 15.0.

Ethical considerations

This study was endorsed by the ethics committee of the

University of Leipzig Medical Faculty based on the princi-

338 H. Danker et al.


ples of the Working Group Medical Ethics Committees in

Germany. All participating patients provided informed

consent.

Results

Description of the sample

A total of 425 laryngectomized patients who had been

treated by participating institutions were registered. 35

(8%) declined participation, 153 (34%) had died by the

time we tried to contact them, 12 (3%) had moved and

could not be found and 35 (8%) had been falsely classi-

fied, i.e. they had not had their larynx removed. A total

of 190 patients ultimately agreed to participate in the

study.

Eleven of these refused to give information concerning

their alcohol consumption. 179 study candidates did pro-

vide information about their alcohol consumption, and

this group ultimately formed the sample for the following

analysis Figure 1.

Of 164 (92%) participants were men, and their average

age upon undergoing laryngectomy was 58-years old

(range: 30–76 years, sd = 9.1). Most of those interviewed

possessed an elementary school education (71%) and

were employed (62%). Social class was calculated based

on income, occupational status and education.27 66%

belonged to the middle class, 27% to the lower and 7%

to the upper class. In most cases, the patients had had a

tumour (n = 97, 54%) in their larynx. 19 patients (10%)

had had a hypopharynx carcinoma, and no further details

could be obtained for the remaining 67 people (36%).

On average, the patients’ laryngectomy (abbreviated with

LE later) had occurred 6 years prior to our study (a span

of 0.1–26 years). 127 (73%) of those interviewed had

received radiation in addition to undergoing a laryngec-

tomy (Table 1).

To assess potential biases of study results, we also

described in Table 1 the sample of participants who

refused to provide information on their alcohol con-

sumption. We saw, however, that there were no signifi-

cant differences in comparison to the study sample. In

addition, only 6% of the interviewers reported having

suspected alcoholism among those who declined to give

information on their alcohol intake.

8000

6000

4000

Alc

oh

ol i

nta

ke (

g/m

)

2000

0

25.00 35.00 45.00 55.00Age

65.00 75.00 85.00

Fig. 1. Alcohol consumption and age.

Table 1. Sample

179 gave

information

on alcohol

consumption

11 refused

information

on alcohol

consumption

Median (span) Median (span)

Age at interview 64 (32–83) 62 (50–77)

Age at operation 58 (30–76) 57 (46–67

Percent (N) Percent (N)

Gender

Male 92 (164) 100 (11)

Female 8 (15) 0

Tumor stage according to UICC

I 6 (7) 0 (0)

II 14 (17) 0 (0)

III 35 (43) 45 (5)

IV 45 (55) 55 (6)

Postoperative radiation

Yes 73 (127) 74 (8)

No 27 (48) 26 (3)

Voice substitute

False whispering 15 (24) 0 (0)

Elektrolarynx 15 (24) 25 (3)

Oesophageal voice 53 (85) 50 (5)

Prosthetic voice 18 (28) 25 (3)

Education

Compulsory school 71 (127) 67 (7)

Post-compulsory school 24 (43) 26 (3)

University level 5 (9) 7 (1)

Occupation

Blue-collar worker 62 (111) 46 (5)

Employee 29 (53) 36 (4)

Civil servant 3 (5) 9 (1)

Self-employed (trade) 6 (10) 9 (1)

Social class

Lower class 27 (45) 19 (2)

Middle class 66 (109) 72 (8)

Upper class 7 (11) 9 (1)



Alcohol consumption

The average alcohol consumption, assessed via FEG, was

967 g ⁄ m (sd 1232.23). Quartiles of alcohol intake were

<97 g ⁄ m, 97–629 g ⁄ m, 630–1265 g ⁄ m and ‡1266 g ⁄ m(minimum 0 g ⁄ m, median 630 g ⁄ m, maximum

7860 g ⁄ m).

Abstinence and low-risk consumption (63%). Eighteen

percent of the study subjects were non-drinkers. 45%

only consumed small amounts.

Risky and dangerous consumption (37%). Fifteen percent

of the interviewed laryngectomy patients consumed risky

levels of alcohol (mean = 1211 g ⁄ m or the equivalent of

averaging two bottles of beer a day). However, about

one-fourth of the people (22%) indicated having

dangerous levels of consumption (mean = 2989 g ⁄ m or

the equivalent of averaging five bottles of beer a day).

Alcohol dependence. It is highly likely that, based on the

above-mentioned cut-off value, 7% of the interviewed

subjects (13 people) had alcohol dependencies as they

reported both abusing alcohol and drinking it in danger-

ous amounts (Table 2).

Motivation to change

In response to the question as to whether their alcohol

consumption had changed post-surgery, 91 people

answered negatively, while 76 people indicated that their

consumption had decreased. A minority of four people

reported that they had been drinking more since their

operation and had no intention of changing anything.

While the majority of those who continued their con-

sumption habits had no wish to change, a minority

(almost 6%) wanted to drink less in the future. No one

in this minority, however, indicated above average or

dangerous alcohol consumption levels (mean = 909 g ⁄ m).

There was only one person in this group who drank an

average six bottles of beer a day. There is a similar picture

among the study subjects who had reduced their con-

sumption post-surgery. Again, only a minority indicated

a desire to make any further changes in their drinking

habits.

Alcohol consumption dependent on medical and social

variables

Regarding age, the amount of alcohol consumed was more

or less normally distributed (Fig. 2). As far as time elapsed

since laryngectomy is concerned, the consumption behav-

iour between the various groups was relatively constant

(Fig. 3). No significant differences in mean values could be

determined (up to 1 year after LE 531 g ⁄ m, 1–2 years after

LE 630 g ⁄ m, 2–5 years after LE 796 g ⁄ m, more than

5 years after LE 422 g ⁄ m, p = 0.64). Based on this result,

alcohol consumption does not appear to increase over time

following treatment. Postoperative alcohol consumption is

also independent of tumour stage (I: 374 g ⁄ m, II: 971 g ⁄ m,

III: 987 g ⁄ m, IV: 1140 g ⁄ m, p = 0.48) social class (lower

class: 976 g ⁄ m, middle class 995 g ⁄ m, upper class

720 g ⁄ m), p = 0.82) occupation (not working:953 g ⁄ m,

employment 1196 g ⁄ m, p = 0.54) and type of voice substi-

tute (false whispering 710 g ⁄ m, electronic device 462 g ⁄ m,

oesophageal voice 672 g ⁄ m, prosthetic voice 348 g ⁄ m,

p = 0.76, Fig. 4).

Mental state and alcohol dependence

In comparison with non-alcoholics, the patients with

alcohol dependencies were in a significantly worse emo-

tional state (VAS, 5.2 versus 6.8, p = 0.04) and had

far more difficulties coping with their illness (VAS, 4.5

versus6.8, p = 0.03). Also, they were in much greater need

of psychosocial assistance (HFB, 13.0 versus 7.0, p =

0.02). Higher anxiety levels were also present (HADS, 9.5

versus 5.0, p = 0.03).

Quality of life and alcohol dependence

Alcoholics and non-alcoholics differed on all 15 of the

EORTC QLQ-C30 subscales including: emotional func-

tioning (73.4 versus 56.1, p = 0.03), shortness of breath

(38.5 versus 60.6, p = 0.04), diarrhoea (9.0 versus 24.2,

p = 0.02) and fatigue (34.8 versus 51.5, p = 0.04). No

Table 2. Alcohol dependence

Result N Portion

Mean alcohol

consumption

(g ⁄ month) Standard-deviation

95% confidence interval

KI minimum KI maximum

No alcohol dependence 167 93% 843.3 1009.8 686.7 1000

Alcohol dependence 13 7% 1309.8 981 717 1902.6



further differences were significant (Table 3). No signifi-

cant differences were found between alcoholics and non-

alcoholics on the EORTC H&N35 scales for patients with

head and neck cancer.

Mental state, quality of life and amount of alcohol

consumed

Although the alcoholics clearly suffered more than non-

alcoholics did, there was not an obvious connection

between levels of alcohol intake and well-being. None of

the instruments used to assess mental state indicated dif-

ferences between those who consumed alcohol in risky or

dangerous amounts and those who were abstinent or had

low risk rates of consumption. The same is true for all

subscales of the EORTC QLQ-C30 and the EORTC

QLQ-H&N35.

Discussion

The present study aims to examine the drinking behav-

iour of patients post-laryngectomy, to find out more

about patients’ motivation to change their consumption

habits and to determine possible interfaces with the

mental state of the study subjects and their quality of life.

We contacted 225 predominantly male patients who had

undergone laryngectomy �6 years ago. Of these, data for

alcohol consumption were available for 179 participants.

35 declined study participation and 11 people refused to

report on their alcohol consumption. They did not differ

from the analysed sample characteristics.

Main findings

Levels of alcohol consumption alone do not correlate

with quality of life or mental state in the present sample

of post-laryngectomy patients; however, clinical indicators

of alcohol dependence do. The individual findings are

discussed later under the appropriate subheading in

detail. What we already want to note here is that screen-

ing patients’ post-laryngectomy for alcohol dependence

should not be based solely on the amount consumed.

422

796630

531

0200400600800

100012001400160018002000

Up to one year after LE One to two years after LE Two to five years after LE More than five years afterLE

Alc

ohol

inta

ke (g

/m)

Fig. 2. Age and amount of alcohol consumption (FEG).

348

672

462

710

0

200

400

600

800

1000

1200

1400

1600

1800

2000

False whispering Electrolarynx Feeding tube voice Prosthetic voiceVoice substitue

Alc

ohol

inta

ke (g

/m)

Fig. 3. Time periods after Laryngectomy and amount of alcohol

consumptiont (FEG).

425 laryngectomized patients registered

225 patients contacted

12 moved/not found35 falsely identified

153 deceased200

179 gave information on alcohol consumption

35 declined study participation11 refused information on

alcohol consumption 46

Fig. 4. Voice substitue and amount of alcohol consumption

(FEG).



Alcohol consumption

Of the 179 people who were willing to give detailed infor-

mation on their drinking habits, 147 (82%) were drinkers

and 32 (18%) were non-drinkers. Other studies on the

subject indicate a wide margin of consumption rates (34–

88%).9–12 Results presented here (82%) correspond to the

higher end of the margin seen in the literature.

We saw that male laryngectomy patients have much

less success enjoying alcohol within limits than their peers

do.28 On the one hand, there is a larger than usual per-

centage of non-drinkers in this group.28 On the other

hand, the people in that group who do drink (37%) are

far more likely to drink dangerous amounts of alcohol

than their peers are. Their intake levels are also conspicu-

ously higher than those of the general population.

Seven percent of these patients were dependent on

alcohol with an average daily consumption of the equiva-

lent of five bottles of beer a day. Men in the general

population drink only half that amount.15 Other studies

on patients with head and neck cancer report figures

similar to ours.10,14

Motivation to change

Half of those patients interviewed had not changed

their drinking habits following laryngectomy. A large

portion of the other half had reduced their consump-

tion, and a small number had increased their intake

post-operation.

Alcohol consumption in relation to medical and

social variables

Alcohol consumption appears to be independent of

tumour stage, type of voice substitute, occupation and

social class. For medical practice, this means that one

cannot come to any clear conclusions about risky behav-

iours based only on medical or socio-demographic char-

acteristics. We could not confirm the common

assumption that alcohol consumption increases with time

elapsed since treatment. Our study results differ from

those of Allison’s study,16 which indicate that characteris-

tics of alcohol consumption are in fact related to time

elapsed since operation and tumour stage. However, this

could be because of a selection of samples of the cross-

sectional study. To make definitive statements about the

interaction of time and alcohol consumption, longitudi-

nally designed studies are needed.

Mental state and alcohol dependence

The participants we questioned who were dependent on

alcohol were in a poorer mental state than those who

were not alcoholic. They reported more problems coping

with their illness and its consequences and considered

themselves to be in a worse emotional state. This state

was characterised more by anxiety than it was by depres-

sive symptoms. Other studies on patients with head and

neck tumour present comparable results.12,18 The rela-

tionship between alcohol consumption and depression

that is frequently found in samples of the general popula-

tion29,30 was not found in the present sample. There was,

however, a relationship to anxiety similar to that reported

in another study.31 It can be assumed that a combination

of anxiety and alcohol consumption indicates a specific

way of coping. Maybe people use alcohol to relieve anxi-

ety associated with this specific disease. Establishing this

would require developing studies that explore consumers’

behaviours and mental states at different times using

questionnaires that focus on coping.

Quality of life and alcohol dependence

The study subjects differed from each other concerning

their levels of emotional functioning and fatigue. Alcohol-

ism clearly corresponded with lower quality of life in

terms of mental burdens. Chronic tiredness and

exhaustion, shortness of breath and diarrhoea are further

Table 3 Quality of life (EORTC QLQ-C30) and alcohol

dependence

Mean values EORTC QLQ-

C30

Not

dependent

Alcohol

dependence

Mental functioning 68.9 62.4

Role functioning 65.0 57.6

Emotional functioning* 73.4 56.1

Cognitive functioning 85.9 78.8

Social functioning 73.3 68.2

Global quality of life 60.3 49.1

Fatigue* 34.8 51.5

Nausea und vomiting 6.8 15.2

Shortness of breath* 38.5 60.6

Pain 23.4 25.8

Insomnia 26.8 45.5

Loss of appetite 18.1 36.4

Constipation 10.2 15.2

Diarrhoea* 9.0 24.2

Financial difficulties 34.0 33.3

EORTC, European Organization of Research and Treatment of

Cancer.

*Difference is significant at the 0.05 level (two-tailed).



symptoms that greatly compromised alcoholic partici-

pants’ overall well-being.

Our conclusions concur with those of other studies

that have determined a connection between alcoholism

and compromised quality of life. One such study found

the general quality of life of non-drinkers to be higher

than that of alcoholics,12 and a further study concludes

that patients with head and neck cancer who abuse alco-

hol are 29 times more likely to have a lower quality of life

than the general population is.19

Mental state, quality of life and amount of alcohol

consumed

We dichotomized the sample (abstinence and low risk

consumption versus risky and dangerous consumption)

to verify the extent to which alcohol intake affected the

psychosocial characteristics of the patients. We discov-

ered an interesting paradox through doing this.

Although the alcoholics in our study clearly suffered

more than non-alcoholics did, there was not an obvious

connection between levels of alcohol intake and well-

being. None of the instruments used to assess mental

state and quality of life detected a difference between

people who consume alcohol in risky to dangerous

amounts and those who are abstinent or have low risk

levels of consumption. Correspondingly, Duffy et al.18

did not find a connection between alcohol consumption

and quality of life in their study on patients with cancer

either.

Limitations of the study

From a methodological point of view, there are a few fac-

tors to consider, which may have affected the make-up of

the sample group. One possibility is that some severely

alcoholic people who may have otherwise developed

cancer died first from alcohol-related problems resulting

in their underrepresentation in our sample.32 Because our

study was conducted �6 years after most of the patici-

pants’ laryngectomy, the death of patients who continued

drinking heavily more immediately following laryngec-

tomy could also have caused an underrepresentation of

those individuals in our sample.

This cross-sectional study points out possible psycho-

social concomitants of alcohol dependence among

laryngectomees, but it cannot deal with the fundamental

question of whether alcohol consumption leads to a

compromise in quality of life and to mental burdens

or if it has the opposite effect. This needs to be

studied further, among other things, using longitudinal

assessment.

Conclusion for medical practice and research

We conclude that laryngectomy patients should be

screened post-operation for psychosocial problems using

an instrument that focuses on alcohol dependence issues.

Because of the psychological criteria included in the

assessment, doing this could lead to a more accurate

identification of psychosocial concomitants associated

with increased postoperative alcohol consumption.

Additional damage to health and the risk of cancer

recurrence or other medical complications could be

determined on the basis of consumption levels alone (see

also6–8). It is important to ask patients about these things

on order to obtain a more accurate picture of their well-

being. The present data show that while 22% of laryngecto-

mized patients consume dangerous amounts of alcohol,

only 7% are alcoholics according to the screening instru-

ment. Over time, ideas have changed about the relationship

between amounts of alcohol consumed and severity of alco-

hol dependence. DSM-IV and ICD-10, for example, don’t

even have specifications concerning consumption rates. It

needs to be emphasised that although the short question-

naire is a useful screening instrument, it should not replace

a comprehensive diagnostic interview. Additionally, the

small proportion of people who met the instrument’s

criteria for alcoholism (only 7%) should be kept in mind

when evaluating the validity of the present findings.

What we can add to the discussion about the relationship

between amounts of alcohol consumed and severity of alco-

hol dependence is that clinical criteria of alcohol depen-

dence (e.g. somatic, mental and social symptoms) could

have greater validity for the evaluation of alcohol-related

psychosocial problems than the mere quantity indication.

Keypoints

• Alcohol dependence was found in 7% of the

patients.

• Alcohol dependence is associated with adverse

psychosocial and medical consequences.

• Quality of life and mental state were independent of

the amount of alcohol consumed.

Conflict of interest

None to declare.

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Alcohol consumption after laryngectomy