Clinicians urged to step up alcohol screening at regular intervals, intervention.
This article first appeared on Wednesday, January 22, 2020 in MedPage Today.
By Kristin Jenkins, Contributing Writer, MedPage Today
More than half of cancer survivors in the U.S. are drinking alcohol, with some going beyond recommended limits and others actually binge drinking, researchers found.
Data from the 2000-2017 National Health Interview Survey on alcohol use and drinking patterns in 34,080 adults with a diagnosis of cancer showed that 56.5% reported using alcohol, according to the study by Nina N. Sanford, MD, of UT Southwestern Medical Center in Dallas, and colleagues.
This included 34.9% of cancer patients who said their alcohol consumption exceeded moderate drinking guidelines and 21.0% who admitted to binge drinking, the authors wrote in the Journal of the National Comprehensive Cancer Network (NCCN).
The study showed that although white race was associated with higher odds of any drinking among cancer survivors, Alaska Natives/American Indians had the highest odds of exceeding moderate drinking levels and engaging in binge drinking. The risk for drinking alcohol at all levels increased with younger age, current or former smoking history, and participation in the more recent survey period.
The study included 6,313 cancer survivors age 50 and younger, and the risks for binge drinking increased over time. Conversely, the risks for drinking or exceeding moderate drinking guidelines did not increase, the researchers said.
"[T]his study shows a gradual but persistent trend in increasing alcohol intake among cancer survivors over the past decade, particularly in binge drinking," the team wrote. "Given that alcohol intake has implications for cancer prevention and is a potentially modifiable risk factor for cancer-specific outcomes, the high prevalence of alcohol use among cancer survivors highlights the need for public health strategies aimed at the reduction of alcohol consumption."
The same associations were observed in a subset of 20,828 patients who reported a cancer diagnosis 5 or more years before the survey was administered. In this subset, 57.1% of patients said they were current drinkers. This included 35.1% who said their drinking exceeded guidelines from the Centers for Disease Control and Prevention (CDC) recommending a limit of one drink per day for women and two drinks per day for men.
In addition, researchers found 20.1% cancer survivors said they engaged in binge drinking (defined as consuming 5 or more drinks on one or more occasions in the past 12 months).
Sanford and co-authors said the survey findings were particularly concerning in the group of cancer survivors ages 18 to 34. Despite emerging evidence that alcohol is associated with worse oncologic outcomes among patients already diagnosed with cancer, 73.5% of young survivors said they drank alcohol and 23.6% met the criteria for binge drinking.
Cancers most often associated with binge drinking -- melanoma, cervical, head and neck, and testicular cancers -- are the types diagnosed most often in younger cancer patients, the researchers added.
In an NCCN news release, Sanford said the researchers were surprised by the high rates of alcohol use, and urged clinicians to increase their efforts to regularly assess alcohol intake in cancer survivors and discuss the potential harms associated with continued drinking.
"We recommend that providers screen for alcohol use at regular intervals and provide resources to assist in cutting down use for those who may engage in excessive drinking behaviors," she said. "Typically, questions about alcohol use are just asked once when the patient first enters the medical system and then copied into subsequent notes as part of the patient's social history."
Asked for his perspective, Jeffrey Peppercorn, MD, MPH, director of the Cancer Survivorship Program at Massachusetts General Hospital in Boston, who was not involved with the study, agreed that clinicians need to step up their game when talking to cancer survivors about modifiable risk factors such as alcohol use and smoking.
"In general, there is room for improvement in how we counsel patients about healthy lifestyle practices after cancer," he told MedPage Today. "There is a need for more research evaluating interventions to improve lifestyle factors, such as alcohol use, smoking, and exercise, that are known to impact cancer outcomes and general health."
The new study demonstrates that alcohol use can be a problem for cancer survivors from every walk of life, Peppercorn continued. "I believe all patients should be screened for excessive alcohol consumption, and we should be prepared to offer assistance and referrals to services for those who need help."
He said the use of pre-clinic or point-of-care screening questionnaires can help clinicians determine alcohol use in cancer survivors, and this may trigger supplemental nursing or social work evaluations, referral to assistance and counseling programs, and targeted educational materials.
In the study by Sanford and colleagues, median patient age was 67, 59.5% of survey respondents were women, and 89.1% were white. Smokers, whether current (16.7% of the total) or former (37.8%), were more likely to drink alcohol, and should be counseled to quit smoking, they said, pointing to evidence about the synergistic impact of smoking combined with alcohol use on some cancer subtypes.
The analysis also showed that the odds of drinking alcohol after a cancer diagnosis increased with non-Hispanic ethnicity, higher income, a high school or university degree, and participation in a later survey period. The odds were also increased in survivors who reported their health status as "good."
Factors associated with increasing risk of binge drinking included male gender, self-reported "good" health status, Alaska Native/American Indian race, higher income, younger age, former or current smoking status, and later survey period.
Also commenting in the NCCN news release, Brandon A. Mahal, MD, of the McGraw/Patterson Center for Population Sciences at Dana-Farber Cancer Institute in Boston, said these results also emphasize that more research on alcohol use is needed for all subsets of survivors of cancer, perhaps with a focus on reduction in patients who feel well and report excessive drinking.
"This behavior is ripe for education and intervention in the survivor population," added Crystal S. Denlinger, MD, of Fox Chase Cancer Center in Philadelphia, who is chair of the panel on NCCN's Clinical Practice Guidelines in Oncology Survivorship, and is also quoted in the news release.
Sanford and co-authors reported having no potential conflicts of interest.
“In general, there is room for improvement in how we counsel patients about healthy lifestyle practices after cancer.”
Jeffrey Peppercorn, MD, MPH, Massachusetts General Hospital
Nearly 35% of cancer patients said their alcohol consumption exceeded moderate drinking guidelines and 21% admitted to binge drinking.
Cancers most often associated with binge drinking -- melanoma, cervical, head and neck, and testicular cancers -- are most often in younger cancer patients.