‘Striking’ Findings for Substance Use Disorders in Some Cancer Types

Cancer survivors have a higher rate of substance use disorders, such as alcohol use disorder, than the general population, recent research found.

Survivors of certain types of cancer have a higher prevalence of substance use disorders, such as alcohol use disorder, a recent study from JAMA Network found.

Substance use disorders do not mean substance abuse or misuse, Devon Check, study author, health services researcher and assistant professor in the department of population health sciences at Duke University School of Medicine, said during an interview with CURE®.

“I should note that these terms are sometimes used inconsistently and interchangeably, but there are distinctions. A substance use disorder is an actual condition, defined with specific criteria and identified using a diagnostic interview,” Check explained. “Substance abuse [or] substance misuse is the use of substances, [such as] prescription medications, drugs you can't obtain without a prescription [and] use of those types of substances in ways that may increase an individual's risk for harm but don't necessarily meet the criteria for a substance use disorder diagnosis.”

The study included 6,101 adult survivors, of which more than half (57%) were aged 65 or older and approximately 62% identified as female.

Among the survivors in the study, the prevalence of active substance use disorders was approximately 4%. Survivors of head and neck cancer, esophageal and gastric cancer, cervical cancer and melanoma were most likely to have a substance use disorder, according to the researchers. Of note, they found that active substance use disorder prevalence was the highest among survivors of head and neck cancer and cervical cancer.

“Those findings were certainly striking,” Check said. “Striking, but not necessarily surprising, because we know that both cervical and head neck [cancers] are causally linked to substance use. It's possible that [patients] with head and neck cancer or cervical cancer came into their cancer diagnosis with substance use disorder already.”

Types of substance use disorders included alcohol consumption, cannabis, opioids, sedatives and stimulants among survivors in the study. Specifically, survivors of head and neck cancer and melanoma had the highest prevalence of alcohol use disorder, researchers established.

“Alcohol use disorder. It's also the most prevalent substance use disorder in the general population, meaning people who don't necessarily have a history of cancer. So, it stands to reason that we see a similar pattern among cancer survivors,” Check said.

Researchers found that cannabis use disorder was the most prevalent among survivors of esophageal and gastric cancer, with a weighted prevalence of 9.42%. However, opioid use disorder along with prescription sedative use disorder was not as common among survivors in general, with a weighted prevalence of less than 1%, respectively.

Potential factors leading to substance use disorders could be physical distress from side effects of treatment, Check said and also noted that some survivors could also have had substance use disorders before cancer.

“Perhaps people come into their cancer diagnosis and treatment with a history of substance use disorder. We know from the broader literature, [regarding] pain and substance use, that uncontrolled or incompletely managed pain does drive unhealthy substance use,” Check added. “Likewise, distress that’s not well managed can also increase substance use and perhaps unhealthy substance use.”

It’s important for patients and survivors — along with their care teams — to “understand that substance use disorder, like any other comorbid medical condition, can make aspects of cancer care more challenging,” Check advised. “Research has shown this [challenge] for [patients] who have either an active substance use disorder or higher substance use in their past, it can be difficult to sort of raise these issues with their clinicians because of concerns about stigma.

“What we hope to do is raise awareness about substance use disorder as a chronic condition like diabetes or cardiovascular disease that is part of cancer survivors’ lives. It's just really important for the cancer care team to understand that whole context so they can provide the best care possible for their patients.”

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