Title : Strategies to identify and raise awareness of alcohol consumption in oncological patients before major cancer surgery. The importance of prompt counselling provided by healthcare providers
Abstract:
Introduction: Healthcare professionals play a crucial role in patient education, as they are often seen as a reliable source of information and counselling. Research has suggested that providing structured guidance when modifying a behavioural practice can increase acceptance and adherence. Certain habits, such as alcohol consumption, are associated with an increased risk of perioperative and postoperative complications, making this a key aspect to address as part of a patient’s optimization.
This project aims to optimise preoperative patients by targeting modifiable risk factors.
Objectives: To analyze the screening methods for alcohol intake, the role of health care providers in raising awareness about alcohol cessation and the acceptance of referral to support services among preoperative oncological patients as a key component of adherence to the NICE clinical guidelines.
Materials and Methods: A retrospective analysis was conducted on patients who underwent pre-assessment for cancer-related procedures or surgery in June 2025 at a single centre in London, United Kingdom. Alcohol consumption status (including units and type of alcohol) and referral to a community-based quitting program were identified from their electronic records.
An optimization protocol was then developed incorporating the AUDIT-C (alcohol use disorder identification test consumption) questionnaire to raise awareness, provide counselling, and facilitate referral of these patients to specialized alcohol cessation programs before surgery. This protocol, titled “Alcohol Cessation Pathway” was implemented during the first week of July 2025, across all pre-assessment units, including day-case surgery, pre-surgical assessment department, and endoscopy department within the hospital.
Data collected included patients with active alcohol consumption, including the number of units consumed weekly, type of alcohol, and the frequency of intake. In addition, the type of cancer this group of patients had and the proportion of patients who were provided with information and who accepted referral was assessed.
Results: Prior to protocol implementation, 58 patients with a median age of 64 years old were evaluated in the pre-assessment units. Of these, 31 patients (53%) screened positive for alcohol consumption, with four male patients (12.9%) and one female patient (3.22%) identified as being at higher risk of alcohol use disorder. The most preferred drink was wine, followed by beer. Although verbal counselling may have been provided, documentation within the pre-assessment notes did not record risk level and referral to community alcohol cessation services.
After implementation of the “Alcohol Cessation Pathway”, 49 patients were evaluated, of whom 23 patients (46%) screened positive for alcohol consumption. Within this group, 2 male patients (8.6%) and 1 female patient (4.3%) reported alcohol intake at a level indicating increased risk for harmful use. All patients received counselling from healthcare professionals, and 2 patients (8.6%) accepted information regarding referral to their local NHS alcohol support service.
Among the patients who were considered at higher risk, the most common cancer type was urological, followed by breast, colorectal, sarcoma and gastric cancers.
Conclusions: Preoperative assessment represents a key stage in patient preparation for surgery, where the role of healthcare professionals in counselling is essential to raise awareness of alcohol consumption. Providing appropriate information and facilitating access to quitting support services can positively influence the reduction of alcohol consumption prior to surgery and reduce withdrawal symptoms during their hospital stay among oncological patients.
