Current substance use in patients with gastric cancer in Southern Iran

Abstract

Background: Psychiatric disorders may affect patients suffering from cancer and substance use disorders. Objective: This study was undertaken to evaluate the prevalence of tobacco and opioid use in patients with gastric cancer in Shiraz, Fars Province and Southern Iran. Materials and Methods: In a hospital survey of 177 gastric cancer patients aged 24 years and more, a semistructured-interview was performed based on SDM-IV criteria during the year 2003. Results: The mean age of the patients was 58.13 (SD=14.03) years. Among the subjects, 50.9% (90) were tobacco dependent (61.5% men and 29.4% women, P < 0.001), while 10 (5.7%) were opioid-dependent (7.3% men and 1.9% women, P =0.16). Tobacco and opioid-dependency were not significantly related to age groups, economical or occupational status. Mean ages of tobacco and opioid-dependants were not significantly different from nondependants. Conclusions: Tobacco and opioid dependency were common problems among gastric cancer patients. This report provides useful information for health planning. Men were at greater risk than women. Treatment programs should focus on all age-groups, all occupations and all income-levels.

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consequences. Psychiatric disorders affect a
significant portion of the patient population,
heidaryt@sums.ac.ir
especially patients with cancer diseases and
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(www.medknow.com).
substance use. Heavy substance users are at greater
risk, however, other patterns of substance use also
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Original Article
Current substance use in patients with gastric
cancer in Southern Iran
SZ Tabei*,
ST Heydari#,
D Mehrabani$,?
SJ Shamsina^,
J Ahmadi§,?
Saberi M Firouzi†
ABSTRACT
Background: Psychiatric disorders may affect patients suffering from cancer and substance use disorders.
Objective: This study was undertaken to evaluate the prevalence of tobacco and opioid use in patients with gastric cancer in Shiraz,?
Fars Province and Southern Iran.
Materials and Methods: In a hospital survey of 177 gastric cancer patients aged 24 years and more, a semistructured-interview
was performed based on SDM-IV criteria during the year 2003.
*#Fars Cancer Registry
Center, Department of
Pathology, Shiraz
University of Medical
Sciences, Shiraz,
#Lorestan University of
Medical Sciences,
Khoramabad,?
$†Gastroenterohepatology
Research Center, Shiraz
University of Medical
Sciences, Shiraz,
^Firouzabad Azad
University, Firouzabad,
§Dept of Psychiatry,
Shiraz University of
Medical Sciences, Shiraz,
Iran
Results: The mean age of the patients was 58.13 (SD=14.03) years. Among the subjects, 50.9% (90) were tobacco dependent
(61.5% men and 29.4% women, P <0.001), while 10 (5.7%) were opioid-dependent (7.3% men and 1.9% women, P=0.16).
Tobacco and opioid-dependency were not significantly related to age groups, economical or occupational status. Mean ages of tobacco?
and opioid-dependants were not significantly different from nondependants.?
Conclusions: Tobacco and opioid dependency were common problems among gastric cancer patients. This report provides useful?
information for health planning. Men were at greater risk than women. Treatment programs should focus on all age-groups, all?
occupations and all income-levels.?
KEY WORDS: Gastric cancer, opioid dependence, substance use, tobacco dependence
INTRODUCTION
characterized the decade prior to 1978. Opioids,
For correspondence:
Seyed Taghi Heydari,
Department of
Biostatistics,
School of Public Health,
Shiraz University of
Medical Sciences,
P.O. Box 71345-1847,
Shiraz, Iran
E-mail:
hallucinogens and hypnotics were all reported as
Substance dependence is a psychiatric disorder.[1,2]
drugs of abuse among the clinical population
Harmful substance use is related to the pattern of studies. Alcohol use also increased substantially in
the later years before 1978.[5] In 1979, the National
Iranian Society for the rehabilitation of the disabled
produce harmful, individual and social ceased to be in charge of drug treatment in our
country and made alcohol a prime target and
provided a new national campaign against drug?
substance-use disorders such as tobacco, opium or
alcohol abuse are among the most common mental
ones.[3] Alcohol use causes more years of potential
life lost through disability and death than tobacco.
In developed nations, a decrease in alcohol use can
be observed, but in developing ones, it is still
increasing.[4]
Before 1978 in Iran, the majority of research studies
on substance abuse were confined to registered
opioid addicts in clinical settings and there were no
studies of young or other nonregistered users. From
these limited sources it appeared that, although
opium had always been the most widely abused
drug in Iran, the pattern of drug use had changed
in the period of the rapid growth of cities, population
movement and the general economic changes, which
abuse too. During the early months of 1980, the
campaign became much stricter with extensive use
of the death penalty for drug trafficking. Two
studies indicated the nature of this problem.
Dalvand et al interviewed 200 newly registered
addicted individuals at the rehabilitation center in
Shiraz, Southern Iran[6] and Agahi and Spencer[7]
studied a sample of the adolescents in Isfahan.
These indicated that after 1979, the clinics were
serving a broader social range of addicted
individuals than before and that action by the
authorities was bringing many recently addicted
individuals to clinics. Heroin use predominated
among those who were urban residents, whereas
the villagers attending the clinics were more likely
to be opium users. One aspect of the pattern of
drug use, which seems to have remained stable in
Iran for many years is the age of initiation. Nearly
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and an explanation of the study and an assurance of
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research was confined to Shiraz in Fars provience, Southern
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may have denied dependency and the true prevalence of opioid-
Tabei SZ, et al.: Patients with gastric cancer in Southern Iran
80% of the samples, whether recent of long stabilized users,
had commenced regular drug use in their 20s or later. This is in
contrast to many western studies which indicated an earlier
onset of regular use.[8,9] It was mentioned that nicotine
dependency was a psychiatric disorder.[1] Life-time prevalence
rates of nicotine/tobacco dependence were reported as 20%
and 24% of total community populations.[9,10] Life-time
prevalence rates of nicotine dependence in Hong Kong were
reported as 27% in male and 1% in female community
population[11] and in Shanghai 39% and 2%, respectively.[11]
RESULTS
Mean age of the total sample (177) was 58.13±14.03 years (age
range=24 to 84 years). Seventy percent (124) were men (Mean
age=60.12±13.13 years) and 30% (53) were women (mean
age=53.47±15.06 years) and there were significant differences
in mean ages (t=2.95, df=175, P=0.004) [Table 1].
The tobacco dependants were younger (58±12.83 years) than
the tobacco nondependants (58.31±15.50 years) (t=0.15,
df=175, P=0.885), but the opioid-dependants were older
Nicotine dependence was more prevalent in males,[12-15] low-(61.80±13.90 years) than the opioid-nondependants
income[10] and less-educated population.[10,11] Over the last two (57.91±14.05 years) (t=0.85, df=175, P=0.396) [Table 1].
decades, there have been few systematic studies on tobacco
use conducted in Iran and the official press announcements on Of the total study population, 10 (5.65%) were opioid dependant
the extent and success of the campaign have been part of the (7.3% of men and 1.9% of women) (X2=2.01, df=1, P=0.150)
available information. A survey conducted on general and 90 (50.85%) were tobacco-dependant (61.5% of men and
population in Shiraz indicated that 26% of males and 3.8% of 29.4% of women) (X2=14.81, df=1, P=0.000). Opioid
females were cigarette smokers.[13]
dependence was not significantly related to gender,
occupational and economical status and age-groups. Tobacco
Little has been known about prevalence of tobacco and opioid-dependence was not significantly related to occupational and
dependence in cancer patients in Iran. As far as we know, this economical status and age-groups. There were significant
is one of the first studies conducted in Shiraz, Iran. This study differences between sex and tobacco dependence (X2=14.81,
attempts to identify the prevalence of opioid and tobacco df=1, P=0.000).
dependence and also to investigate the epidemiological
characteristics of opioid and tobacco dependants among Table 2 summarizes the frequency distributions of sex, age
patients with gastric cancer in Shiraz, Southern Iran, with a range, marital status, income, tobacco and opioid-dependants.
population of 1,500,000.
DISCUSSION
MATERIALS AND METHODS
A possible limitation of this survey and many other
One hundred and seventyseven consecutive gastric cancer epidemiological studies of substance use, are under-reporting.
patients, aged 24 years and more, from teaching hospitals Opioid-use is widely considered to be harmful, but in addition,
affiliated to Shiraz University of Medical Sciences entered our in Iran there are legal penalties. Accordingly, some subjects
study. Assessment of tobacco and opioid dependency was done
by using a semi structured interview based on DSM-IV use disorders in gastric cancer patients is probably higher than
criteria.[14] Informed consent was obtained from all participants has been revealed. It should also be mentioned that this
confidentiality were given too. The items selected for use in
the study were based on DSM-IV criteria. Interviews were
conducted in the hospitals. The semi structured interview
included questions on age, gender, marital, occupational and
economical status and current tobacco and opioid use. Categories
of occupation included: housewife, government employee,
unskilled worker, unemployed and self-employed, Economical
status was categorized at very low, low, medium and high,
according to the official average income of Iranians.
Statistical analyses included both descriptive statistics and
inference statistical procedures. Data analysis performed using
SPSS software (Version Chicago, IL). Chi-square was used to
test for differences in frequencies and t-test was used to test
for differences in means. These were two-sided with
significance set at P<0.05.
Iran and care must therefore be taken not to generalize these
findings for the full Iranian patients population.
Fault could perhaps be found with our categorization of
occupations and income, however, the chosen categories best-
suited the population under consideration.
Table 1: Mean age and standard deviation by sex, tobacco
dependants and opioid-dependants
Mean
60.12
53.47
58.00
SD
13.13 2.95 175
15.06
12.83
15.50 0.15 175
13.90
14.05 0.85 175
t df Significance
0.004
-
-
0.885
-
0.396
Male
Female
Tobacco dependants
Tobacco nondependants 58.31
Opioid- dependants
Opioid nondependants
SD - Standard deviation
-
-
­
­
61.80
57.91
-­
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of the problem in patients with gastric cancer. As mentioned,
a site hosted by Medknow Publications
(www.medknow.com).
Tabei SZ, et al.: Patients with gastric cancer in Southern Iran
Table 2: Frequency distribution of age, sex, tobacco
dependants, opioid-dependants, income and occupation
in gastric cancer patient
Number
124
53
11
22
40
36
44
24
Percent
70.1
29.9
6.2
12.4
22.6
20.3
24.9
13.6
Sex?Male
Female
<35
35-44
45-54
55-64
65-74?
75+
Age?
results suggested that substance use extended across all
occupations.
As with the occupations, substance dependency was spread
across the income spectrum. Similarities were to be expected,
of course, as occupation and income were interconnected.
Tobacco and opioid dependency are common in gastric cancer
Income
Tobacco
patients (and probably the whole of cancer patients). Both are
significantly greater in males. They are not a function of age
Mean= 58.13 yr, minimum=24, maximum=84, SD= 14.03
High
Medium
Low?
Very low
Dependent
Nondependent
Dependent
Nondependent
Self-employed
Occupation Governmentemployed
Unskilled worker
Housewife
Married
Marital status? Single
Widow
groups and both are found across the occupational and income
6
60
16
93
90
87
10
167
17
22
69
69
169
5
3
3.4
34.3
9.1
53.1
52
48
5.6
94.4
9.6
12.4
39
39
95.5
2.8
1.7
spectrums. Dependency extended across all age-groups and
treatment programs needed to be available for all. These results
should be considered in planning of preventive and therapeutic
programs for gastric cancer patients in Iran.
ACKNOWLEDGMENTS
We would like to thank the Office of Vice-Chancellor for
Research of Shiraz University of Medical Sciences for financial
support and the Center for Development of Clinical Studies of
Nemazee Hospital for editorial, statistical and typing assistance.
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