Increased Substance Use Among Young Cancer Survivors Highlights Need for Focused Efforts for Interventions, Pain Management

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Adolescent and young adult cancer survivors were more likely to misuse substances including drugs and alcohol compared with their peers without a history of cancer, which may be a result of overprescribing from doctors or inefficient pain management.

Adolescent/young adult (ages 12-34) cancer survivors were more likely to use and misuse alcohol and drugs compared with their peers without a history of cancer, according to data from a national survey published in Cancer.

Adolescents/young adults are at challenging and developmental period in their lives which often leads to risky and unhealthy habits, the study authors note. A survivor of adolescent/young adult cancer can have the risk of cancer-related death increased by using and misusing substances such as drugs and alcohol, and despite this increased risk, adolescent/young adult survivors continue to partake in unhealthy behaviors.

“To better inform interventions to prevent and reduce substance use and substance misuse, there has been a critical need to fully understand the current prevalence and patterns of substance use, misuse and addiction among (adolescent/young adult) cancer survivor as compared to the general population,” said Xu Ji, who holds a PhD in public health and is an assistant professor in the department of pediatrics at Emory University School of Medicine and Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta, in an interview with CURE®. “Unfortunately, to date, this area has been seriously understudied.”

Researchers assessed substance use, misuse (defined by Ji as using a larger amount of a substance than directed by a provider) and disorders in the past year among survivors of adolescent/young adult cancer. Using a national survey, researchers identified 832 adult/young adolescent cancer survivors and 140,826 adolescents/young adults with no history of cancer. Outcomes assessed included use of tobacco, alcohol, marijuana and illicit drugs, as well as misuse of prescription opioids, substance use disorders (defined by the authors as “past-year abuse or dependance on a substance”) and treatment.

In the past year, compared with patients without a cancer history, adolescent/young adult survivors were 6% more likely to use alcohol, 34% more likely to use illicit drugs and 59% more likely to misuse prescription opioids. In addition, survivors were 77% more likely to have an illicit drug use disorder, 67% more likely to have a marijuana use disorder and 67% more likely to have a prescription drug use disorder.

“We found that the increased rate of substance use and substance use disorders among (adolescent and young adult) cancer survivors, as compared to their peers without cancer, were largely … explained by their differences in physical and mental health care needs,” Ji said. “One of the possible reasons to explain this is (that) there is an increased rate of experiencing physical and mental health problems (in survivors) associated with their cancer diagnoses, treatment and general cancer experience.”

When adjusting for health status — specifically depression — there was no difference between survivors and non-survivors in reporting alcohol and drug use, although survivors were 41% more likely to misuse prescription opioids.

“This (percentage of prescription opioid use) is relatively large in terms of magnitude,” Ji said. “We think that this finding may at least partially reflect survivors’ increased need for opioids to avoid pain or to help address some of their pain problems. In fact, in our data, we found that the vast majority — and more specifically 64% of the (adolescent and young adult) cancer survivors — reported that the main reasons for misusing prescription opioids was to relieve their physical pain.”

Survivors were one to two times more likely to receive treatment for a substance abuse disorder compared to those with no history of cancer (21.5% versus 8%).

“That's actually a relatively good side of the entire story,” Ji said. “It's possible that survivors have increased engagement in the health care system because of cancer treatment already. These can provide (patients) more opportunities to identify their substance use problems and also to intervene their substance use problems.”

However, only one in five survivors received treatment for a substance abuse disorder.

Ji said that overprescribing opioids and poorly controlled pain may also play a role in this increased substance misuse and abuse.

“Under the current and still ongoing pandemic exacerbated opioid crisis, it's possible that overprescribing of opioids, in combined with lack of knowledge and awareness of safer use of prescription opioids, may lead to the increased misuse of opioids among (adolescent and young adult) cancer survivors,” she said. “On the other hand, because of our (wide) definition of misuse … it's also possible that opioid misuse may reflect poorly controlled pain or badly controlled pain among survivors. Therefore, it's likely that survivors may self-medicate themselves then using larger amount or more frequently or longer duration of prescription opioids than a doctor's guidance.”

Findings from this study highlight the need for more efforts focused on adolescent and young adult cancer survivors.

“I think our findings underscores the need for future efforts or interventions to prevent and reduce substance use problems among (adolescent/young adult) cancer survivors,” Ji noted. “We think that significant efforts are really needed to enhance communication between providers, survivors and caregivers of survivors in order to raise young survivors’ awareness of their increased risk for adverse health complications compared to their peers and also the increased risks associated with their severe substance use behaviors.”

Ji notes that teaching survivors coping methods to turn to instead of substance use would help. She also adds that providers who regularly see adolescent/young adult cancer survivors should be assessing substance use among their patients, referring them treatment and eventually explore treatment that do not involve opioids.

There were a few limitations of this study including a lack of data on cancer diagnosis and timing, so researchers were unable to determine whether there was an association between the timing of a cancer diagnosis and substance use. In addition, information was not available regarding whether a patient used substances before a cancer diagnosis.

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