Heavy alcohol consumption plays a synergistic role with heavy tobacco consumption in the development of head and neck squamous cell cancers, commonly known as cancer of the mouth, nose or throat. But the intense stigma associated with heavy drinking can lead patients to hide information when transparency is needed the most.
As a cancer specialist, I’ve had less-than-honest conversations with patients and I know how much they can hurt a provider’s attempts to treat a patient as effectively as possible.
Creating family friction
A patient’s guilt or fear of embarrassment about drinking usually crops up during the initial consultation. This is when we ask patients for a social history, including whether they’re currently using tobacco, street drugs or alcohol, or have in the past.
Often we notice a discrepancy between the information we get from a patient and what we get from family members. When this happens, it creates an awkward situation where we may unintentionally create friction between patient and family. It also creates a conundrum because it becomes nearly impossible to get an accurate social history for the patient.
No judgment here
Before I ask patients sensitive questions, I always emphasize that I am not judging them. I merely want to get an accurate history of how much they drink since it does affect care following cancer surgery.
Patients who drink daily may be physiologically dependent on alcohol. This can be true whether they drink two or 20 alcoholic beverages a day. Some patients are aware that they’re dependent, but others aren’t.
Help with withdrawal
If we believe a patient is dependent on alcohol, the surgical staff can help with the Clinical Institute Withdrawal Assessment for Alcohol. The CIWA is a 10-item list used to diagnose physiological dependence and help patients through withdrawal.
Alcohol withdrawal symptoms can range from tremors to psychomotor agitation, which includes restlessness, pacing and rapid talking. In some cases, symptoms can progress to seizures and even death. It’s crucial for clinicians to be aware of the potential for alcohol withdrawal so we can help patients manage it safely.
Minimizing health risks
It’s not uncommon for patients to minimize their drinking history, again, likely out of guilt and the stigma attached to heavy drinking. But when I have this experience with a patient, it feels like being struck by a freight train that should have been easily spotted and heard, even a mile away.
Hiding the truth can create a dense fog that prevents a provider from seeing what’s coming. As uncomfortable as it might be, providing an accurate health history will help your physician provide the best care possible and minimize any potential risks.