Risky Drinking Common in Cancer Survivors

Megan Brooks

August 23, 2023

Alcohol consumption, including risky drinking behaviors, is common among adult cancer survivors, even people currently receiving cancer treatment, new research shows.

An analysis of more than 15,000 adults with a cancer diagnosis revealed that nearly 80% were current drinkers. Among current drinkers, 13% consumed a moderate amount of alcohol in a typical day, while close to 40% engaged in hazardous drinking.

The numbers are "staggering," Yin Cao, ScD, MPH, of Washington University School of Medicine, St. Louis, Missouri, told Medscape Medical News. "Most concerning," said Cao, "is that those on cancer treatment are engaged in a similar level of risky drinking."

The study was published online August 10 in JAMA Network Open.

Drinking alcohol can increase a person's risk for a variety of cancers, including oral and pharyngeal cancer as well as esophageal, colorectal, liver, and female breast cancers.

Consuming alcohol is also associated with numerous risks among people diagnosed with cancer. In the short term, alcohol consumption can worsen post-surgical outcomes as well as impair cognition and amplify cardiotoxicity in patients undergoing chemotherapy. In the long term, drinking alcohol can elevate a person's risk of recurrence, secondary tumors, and mortality.

The American Society of Clinical Oncology (ASCO) recently issued a statement reinforcing the need to prioritize alcohol consumption as a key modifiable behavioral factor in the cancer control research agenda.

The current American Cancer Society guidelines indicate that it's best to avoid or, at least, minimize alcohol consumption. Men should limit their intake to no more than two drinks per day and women should have no more than one drink per day.

Despite this data and guidelines, alcohol drinking patterns among cancer survivors in the US remain poorly understood.

To explore further, the researchers identified 15,199 adult cancer survivors enrolled in the National Institutes of Health (NIH) All of Us Research Program.

Overall, 78% of the cohort — more than 11,800 individuals — were current drinkers. In a typical day, 24% engaged in binge drinking — consuming six or more drinks on a single occasion — and 38% engaged in hazardous drinking. Using the Alcohol Use Disorders Identification Test-Consumption, or AUDIT-C, the researchers classified hazardous drinking as scores of four or higher in men and three or higher in women.

Drinking patterns looked similar in the subset of 1839 patients undergoing cancer treatment. In this group, 76% were current drinkers. Among current drinkers, 12% exceeded moderate drinking levels, 23% reported binge drinking, and 38% engaged in hazardous drinking. In this group, men, Hispanics, people diagnosed with cancer before age 18, and smokers were more likely to engage in risky drinking behaviors.

"We know that many people who are diagnosed with cancer continue to drink alcohol, but this study provides much more detailed information about that," said Farhad Islami, MD, PhD, senior scientific director for cancer disparity research at the American Cancer Society, Atlanta, Georgia, who was not involved in the study.

Given the degree of drinking identified in this population, Cao highlighted the importance of talking to patients about alcohol.

"Our findings highlight an opportunity for enhanced support and intervention concerning risky drinking behaviors" in oncology, Cao said. "Given the societal norms surrounding alcohol and the general lack of awareness of alcohol's short- and long-term impact on cancer outcomes, gently educating patients/survivors about potential risks while understanding the cultural and societal contexts of drinking can make a difference."

Islami agreed that oncologists should talk to their patients about alcohol, "especially those going through active treatment because alcohol may affect the treatment or may be associated with more complications of the treatment."

"Many people now know that smoking causes cancer, but unfortunately, many people do not know about the association of alcohol with cancer," he said.

Outside of an awareness gap, there are numerous risk factors for substance abuse among cancer survivors, Marleen Meyers, MD, director of the Cancer Survivorship Program at NYU Langone Perlmutter Cancer Center, New York City, explained.

Alcohol can help some cancer survivors dull feelings of isolation, fear, stress, and poor pain management that may accompany their diagnosis and treatment, said Meyers, who was not involved in the research. That is why "it is important for patients to be honest with their providers and for providers to ask about substance use in a nonjudgmental way."

In these conversations, oncologists should educate patients about the safety risks associated with alcohol intake during or after treatment and that there is no established "safe" amount of alcohol. Incorporating a mental health screening and questions about a family history of substance abuse can also help identify patients "most at risk so providers can be proactive," she said.

The study was supported by a grant from the NIH. Cao, Islami and Meyers report no relevant financial relationships.

JAMA Netw Open. Published online August 10, 2023. Full text.

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