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Background: Substance misuse is common among cancer survivors and can negatively impact cancer outcomes., Methods: We conducted a cross-sectional study using National Survey on Drug Use and Health data for 2015 to 2020. We included adult respondents with a history of solid tumor cancer. We calculated the weighted prevalence and corresponding SEs (both expressed as percentages) of substance (alcohol, opioid, sedative, stimulant, other) misuse for respondents with any history of solid tumor cancer and, in secondary analyses, respondents diagnosed with cancer in the prior 12 months., Results: The study included 6,101 respondents with any history of cancer, 1,437 diagnosed in the prior 12 months. Alcohol was the most commonly misused substance. The average prevalence of alcohol misuse was 14.4% (SE 0.60%) across cancer types; it was markedly more common among people with a history or cervical (24.2% [3.0%]) or head and neck cancer (27.4% [7.1%]). The next most common form of substance misuse was opioid misuse (average prevalence: 2.7% [0.25%]). As with alcohol misuse, the prevalence of opioid misuse was higher among those with a lifetime history of cervical cancer (5% [1%]) or head and neck cancer (5% [3%]). Results were generally consistent among cancer survivors diagnosed in the prior 12 months., Conclusions: There is a clear opportunity to address substance misuse-particularly alcohol misuse-among cancer survivors. Such efforts should focus on populations with a high prevalence of substance misuse (e.g., cervical and head and neck cancer survivors) and have strong potential to improve cancer-specific and overall health outcomes., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Importance: Some individuals are predisposed to cancer based on their substance use history, and others may use substances to manage cancer-related symptoms. Yet the intersection of substance use disorder (SUD) and cancer is understudied. Because SUD may affect and be affected by cancer care, it is important to identify cancer populations with a high prevalence of SUD, with the goal of guiding attention and resources toward groups and settings where interventions may be needed., Objective: To describe the cancer type-specific prevalence of SUD among adult cancer survivors., Design, Setting, and Participants: This cross-sectional study used data from the annually administered National Survey on Drug Use and Health (NSDUH) for 2015 through 2020 to identify adults with a history of solid tumor cancer. Substance use disorder was defined as meeting at least 1 of 4 Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for abuse or at least 3 of 6 criteria for dependence., Main Outcomes and Measures: Per NSDUH guidelines, we made adjustments to analysis weights by dividing weights provided in the pooled NSDUH data sets by the number of years of combined data (eg, 6 for 2015-2020). The weighted prevalence and corresponding SEs (both expressed as percentages) of active SUD (ie, within the past 12 months) were calculated for respondents with any lifetime history of cancer and, in secondary analyses, respondents diagnosed with cancer within 12 months prior to taking the survey. Data were analyzed from July 2022 to June 2023., Results: This study included data from 6101 adult cancer survivors (56.91% were aged 65 years or older and 61.63% were female). Among lifetime cancer survivors, the prevalence of active SUD was 3.83% (SE, 0.32%). Substance use disorder was most prevalent in survivors of head and neck cancer (including mouth, tongue, lip, throat, and pharyngeal cancers; 9.36% [SE, 2.47%]), esophageal and gastric cancer (9.42% [SE, 5.51%]), cervical cancer (6.24% [SE, 1.41%]), and melanoma (6.20% [SE, 1.34%]). Alcohol use disorder was the most common SUD (2.78% [SE, 0.26%]) overall and in survivors of head and neck cancer, cervical cancer, and melanoma. In survivors of esophageal and gastric cancers, cannabis use disorder was the most prevalent SUD (9.42% [SE, 5.51%]). Among respondents diagnosed with cancer in the past 12 months, the overall prevalence of active SUD was similar to that in the lifetime cancer survivor cohort (3.81% [SE, 0.74%]). However, active SUD prevalence was higher in head and neck (18.73% [SE, 10.56%]) and cervical cancer survivors (15.70% [SE, 5.35%]). The distribution of specific SUDs was different compared with that in the lifetime cancer survivor cohort. For example, in recently diagnosed head and neck cancer survivors, sedative use disorder was the most common SUD (9.81% [SE, 9.17%])., Conclusions and Relevance: Findings of this study suggest that SUD prevalence is higher among survivors of certain types of cancer; this information could be used to identify cancer survivors who may benefit from integrated cancer and SUD care. Future efforts to understand and address the needs of adult cancer survivors with comorbid SUD should prioritize cancer populations in which SUD prevalence is high.

Background: Substance misuse is common among cancer survivors and can negatively impact cancer outcomes. Methods: We conducted a cross-sectional study using National Survey on Drug Use and Health data for 2015 to 2020. We included adult respondents with a history of solid tumor cancer. We calculated the weighted prevalence and corresponding SEs (both expressed as percentages) of substance (alcohol, opioid, sedative, stimulant, other) misuse for respondents with any history of solid tumor cancer and, in secondary analyses, respondents diagnosed with cancer in the prior 12 months. Results: The study included 6,101 respondents with any history of cancer, 1,437 diagnosed in the prior 12 months. Alcohol was the most commonly misused substance. The average prevalence of alcohol misuse was 14.4% (SE 0.60%) across cancer types; it was markedly more common among people with a history or cervical (24.2% [3.0%]) or head and neck cancer (27.4% [7.1%]). The next most common form of substance misuse was opioid misuse (average prevalence: 2.7% [0.25%]). As with alcohol misuse, the prevalence of opioid misuse was higher among those with a lifetime history of cervical cancer (5% [1%]) or head and neck cancer (5% [3%]). Results were generally consistent among cancer survivors diagnosed in the prior 12 months. Conclusions: There is a clear opportunity to address substance misuse—particularly alcohol misuse—among cancer survivors. Such efforts should focus on populations with a high prevalence of substance misuse (e.g., cervical and head and neck cancer survivors) and have strong potential to improve cancer-specific and overall health outcomes. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Upon completion, participants will be able to list cancer populations (ie, by cancer type) that have a higher relative prevalence of substance use disorders (SUD), as well as commonly used substances 2. Upon completion, participants will demonstrate an appreciation of the need for targeted intervention development efforts to address concurrent cancer/SUD in high-SUD prevalence cancer populations Despite the close connection between cancer and substance use (with some individuals predisposed to cancer due to their substance use history and/or using substances to cope with cancer-related distress) the prevalence of substance use disorders (SUD) among people with cancer is unknown. We characterized overall and cancer type-specific prevalence of SUD to identify populations that may benefit from interventions aimed at mitigating the negative effects of SUD on cancer and pain outcomes. We used data from the cross-sectional National Survey on Drug Use and Health (2015–2020), which includes information on current SUD (assessed using DSM criteria) and cancer history. We calculated the weighted population prevalence of SUD and corresponding standard errors (both expressed as %) among adults with any history of solid tumor cancer. Among 6,101 respondents with a history of cancer, overall SUD prevalence was 3.83% (0.32%). Alcohol was most common (2.78% (0.26%)), followed by stimulants (0.50% (0.10%)), cannabis (0.46% (0.10%)), opioids (0.43% (0.10%)), and sedatives (0.12% (0.04%)). SUD were most prevalent in head/neck cancers (9.74% (2.33%)), esophageal/gastric cancers (9.17% (3.36%)), cervical cancer (6.32% (1.24%)), and melanoma (5.46% (1.12%)). The distribution of specific substances differed by cancer type. For example, in head/neck cancers, as in the overall sample, alcohol accounted for most SUD (7.47% (1.89%)); however, sedatives were more common in this group (1.38% (1.36%)) than in the overall sample. In gastric/esophageal cancers, cannabis was most common (6.94% (4.32%)), followed by opioids (2.23% (2.24%)). In certain cancers, SUD are as prevalent as other common comorbidities (eg, diabetes, depression). Despite the prevalence and known consequences of untreated SUD (eg, for cancer pain management), and existence of effective treatments for SUD, the field lacks strategies to manage SUD and cancer concurrently. Future studies should target high-SUD prevalence cancer types and identify strategies to improve care integration. [ABSTRACT FROM AUTHOR]

1. Participants will be able to identify subpopulations of cancer survivors (based on cancer type) that have a high prevalence of substance misuse. 2. Participants will be able to identify substances that are commonly misused among cancer survivors. We present actionable data on high substance misuse-prevalence cancer populations that highlight the need for targeted interventions in these groups. Based on our results, implementing evidence-based interventions for alcohol misuse (e.g., screening, brief intervention, treatment) in cervical and head/neck cancer care settings may be particularly impactful. Substance misuse (i.e., high-risk use that does not meet criteria for use disorder but may result in harm) is at least as prevalent among cancer survivors (people diagnosed with cancer) as it is in the general population. Among cancer survivors, substance misuse is associated with poor cancer outcomes. To generate cancer type-specific estimates of substance misuse, with the goal of guiding attention and resources towards populations where interventions are most needed. We used data from the National Survey on Drug Use and Health (2015-2020) to calculate the weighted population prevalence of substance misuse and corresponding standard errors (both expressed as %) among adults with any solid tumor cancer history, overall and by cancer type. Misuse was defined as: binge drinking (alcohol), use other than prescribed (prescription drugs), or any nonmedical use. Substance categories included: alcohol, opioids (illicit and prescription), sedatives (prescription sedatives and tranquilizers), and stimulants (prescription, methamphetamine, and cocaine). We excluded cannabis in the absence of established definitions of misuse. Among 6,101 cancer survivors, the prevalence of alcohol misuse was 14% (0.6%). Opioid misuse was less common (3% [0.3%]), as were sedative and stimulant misuse (< 2% each). With respect to cancer type-specific prevalence, substance misuse was highly prevalent among cervical and head/neck cancer survivors, including for alcohol (cervical: 24% [3%], head/neck: 27% [7%]) and opioids (cervical: 5% [1%]), head/neck: (5% [3%]). Results were consistent in a sub-cohort of 1,437 cancer survivors diagnosed with cancer in the past year, with the highest rates of substance misuse observed in cervical and head/neck cancers. Efforts to address substance misuse should target patients with cervical and head/neck cancers. Evidence-based interventions for alcohol (e.g., screening, brief intervention, treatment) may be particularly impactful. Our results are actionable, elucidating clear opportunities to address substance misuse in cancer survivors. Palliative care in oncology/Psychosocial support [ABSTRACT FROM AUTHOR]