ORIGINAL ARTICLE Association between alcoholism and symptom expression, patient symptom goals, and clinical response in advanced cancer patients Sebastiano Mercadante 1,2 & Claudio Adile 1 & Patrizia Ferrera 1 & Alessandra Casuccio 3 Received: 5 August 2019 /Accepted: 24 October 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Aim 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. Methods 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 improve- ment or deterioration at T7 (bit better or a little worse, respectively). Results 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 signifi- cance 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. Conclusion 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. Keywords Advanced cancer patients . Symptom burden . Alcoholism . Patients’ goals . Global impression . Clinical response Introduction Patients with advanced cancer develop a relevant symptom burden during the course of disease [1]. Some life habits may influence the symptom expression through different mechanisms. A high percentage of patients in USA are con- suming alcohol. They have been found to present higher levels of pain [2], to be referred earlier to palliative care, to have more symptom expression, a more frequent use on opi- oids [3], and to have a history of smoking or illegal use of drugs [4]. Moreover, alcoholism can lead to several comor- bidities that may have an impact on treatment outcomes and quality of life [5, 6]. However, the association between symp- tom burden and alcohol habits in patients with advanced can- cer and the response to pain and symptom management is unclear, as it has not well characterized longitudinally [7–9]. The clinical response in advanced cancer patients is not easy to determine. The minimal clinically important difference (MCID), which is the smallest amount of change required to * Sebastiano Mercadante terapiadeldolore@lamaddalenanet.it; 03sebelle@gmail.com 1 Main Regional Center for Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy 2 Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via san Lorenzo 312, 90145 Palermo, Italy 3 Department of Sciences for Health Promotion and Mother Child Care, University of Palermo, Palermo, Italy Supportive Care in Cancer https://doi.org/10.1007/s00520-019-05152-x