Substance use disorder varies among survivors depending on type of cancer
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Key takeaways:
- Survivors of gastro-esophageal and head and neck cancers more likely had a substance use disorder.
- Cancer survivors use alcohol more than any other substance.
Substance use disorders are more prevalent among survivors of certain types of cancer, according to study results published in JAMA Oncology.
Roughly 4% of cancer survivors had substance use disorders (SUDs), but they occurred significantly more in individuals with esophageal and gastric cancers and head and neck cancers. Those with cervical cancer or melanomas also had moderately higher rates.
“Among people diagnosed with certain types of cancers — like cervical and head and neck cancers — the estimated prevalence of SUD is similar to those of medical comorbidities like diabetes and cardiopulmonary conditions,” Devon K. Check, PhD, leader of clinical initiatives and assistant professor at Duke University, told Healio.
“Within the field, there is an increasing emphasis on ensuring that people diagnosed with cancer have access to integrated care for their comorbid medical conditions,” she added. “Similar efforts for people who concurrently manage cancer and SUD are largely absent but critically needed. These efforts should prioritize cancer populations where SUD prevalence is high.”
Background and methods
Risk factors for cancer include increased alcohol, tobacco and substance use, and cancer survivors can turn to drugs or other substances to cope with their diagnosis, according to background information provided by researchers.
However, survivors with SUDs may not receive proper treatment for their cancer or substance issues.
“Substance use and use disorders are on the rise in general and among older adults, who represent the majority of people diagnosed with cancer,” Check said. “Substance use disorders have significant potential to complicate cancer care and negatively impact cancer outcomes. Yet, we know very little about how common SUDs are among people diagnosed with cancer. Specifically, we thought it was important to understand whether SUDs are more common with certain types of cancers. We can use that information to guide resources toward populations where interventions to integrate SUD treatment and cancer treatment are most needed.
“In addition, because different SUDs, such as opioid use disorder and alcohol use disorder, might complicate cancer treatment in different ways and necessitate different types of interventions, we thought it was important to understand the distribution of specific disorders.”
Check and colleagues used the annual National Survey on Drug Use and Health (NSDUH) to determine any correlation between SUD and various cancers. The NSDUH measures SUD prevalence for the previous 12 months.
The study cohort included individuals aged at least 18 years with any solid tumor cancer in their history.
Results
The study population consisted of 6,101 cancer survivors (56.9% aged at least 65 years; 61.6% women; 83.2% white).
Survivors of breast cancer made up the largest proportion of the study population (26.1%), followed by prostate and testicular cancers (15.6%) and melanoma (8.1%).
SUD appeared in 3.8% of survivors. Individuals with esophageal and gastric cancers (9.4%); head and neck cancers (9.7%); cervical cancer (6.2%); melanoma (6.2%); larynx, trachea and lung cancers (5.4%); ovarian cancer (4.3%); and prostate and testicular cancers (4.1%) had higher rates.
Alcohol use disorder appeared in 2.8% of survivors. Individuals with head and neck cancers (6.9%); melanoma (5.5%); larynx, trachea and lung cancers (4.8%); cervical cancer (4.2%); ovarian cancer (3.7%); and prostate and testicular cancers (3.6%) had higher rates.
“The average prevalence of SUD, or the prevalence across cancer types, was lower than we might have expected,” Check said. “However, that makes a lot of sense in the context of a couple of important factors. First and foremost, our study population was older and mostly female, given the high prevalence of breast cancer in the study population. SUDs are less common among older adults compared with younger adults, although SUD prevalence is rapidly increasing among older adults and among women compared with men.
“Alcohol use disorder is the most common SUD in the general U.S. population, and that was true for our study population of cancer survivors as well,” Check added. “Additionally, SUD prevalence was higher in cancers like cervical cancer and head and neck cancers that are causally linked to alcohol and/or tobacco use — both of which are associated with use of other substances.”
Cannabis use disorder appeared in just under a half percent of the population, but survivors of esophageal and gastric cancers had drastically higher rates (9.42%).
Survivors of head and neck cancers had significantly higher rates vs. the average of opioid use disorder (1.4% vs. 0.43%) and sedative use disorder (1.82% vs. 0.12%), survivors of cervical cancer had higher rates of opioid use disorder (0.93% vs. 0.43%) and stimulant use disorder (1.51% vs. 0.5%), and survivors of colon and rectal cancer had higher rates of stimulant use disorder (1.65% vs. 0.5%).
“Other researchers have shown that our study data source may underestimate the prevalence of opioid use disorder by a factor of 3 to 5,” Check said. “As a result, our estimates of opioid use disorder, and overall SUD, are likely underestimates.”
A secondary analysis of the prior 12 months produced similar overall results, although SUD occurred at much higher rates for survivors of head and neck cancer (18.73%) and cervical cancer (15.7%).
“We need to understand more about the specific challenges that arise at the intersection of cancer and SUD so we can design interventions and programs to better support both patients who concurrently manage cancer and SUD and the clinicians who care for them,” Check said.
For more information:
Devon K. Check, PhD, can be reached at devon.check@duke.edu.
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