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ALCOHOL AND CANCER
Despite being a risk factor for cancer, alcohol consumption remains high among cancer fighters and survivors according to a new study, worrying many in the medical field.

It is a few days after you received the great news: you’re in remission. You decide to have a little drink to celebrate. Grabbing a beer or two or 10 was the norm for you during your teen years and not much has changed since. Before your diagnosis, you would grab a couple of drinks after work during happy hour with your coworkers or pour a few glasses of wine during dinner. What hurt can one extra drink cause in the grand scheme of things?

A lot, at least according to new research published in the January 2020 issue of JNCCN, Journal of the National Comprehensive Cancer Network. The study—the first-ever study on the drinking habits of cancer survivors—surveyed 34,080 participants from 2000 to 2017 through the National Health Interview Survey (NHIS) to examine the drinking habits of people with a cancer diagnosis. From the participants, 56.5 percent were current drinkers, 34.9 percent exceeded moderate drinking levels and 21 percent engaged in binge drinking. The results, according to researchers, were surprising not only because they were so high, but because alcohol has been identified as a risk factor for several cancers. According to a 2013 report from the National Cancer Institute, alcohol consumption was responsible for 3.5 percent of all cancer deaths.

“We found that to be concerning because alcohol is a risk for several different malignancies, but it’s also a risk for poor outcomes among individuals who have cancer,” says study researcher Brandon A. Mahal, M.D., of the Dana Farber Cancer Institute. “It can interfere with some chemotherapies, it can make recovery from treatments worse. There’s some suggestions that consuming alcohol can lead to a higher rate of progression on some diseases.

The study used CDC guidelines to define excessive drinking as more than one drink per day for women, and more than two drinks per day for men. Binge drinking was defined as the consumption of at least five drinks in one day at any point over the past year.

The results were even more severe when looking at younger survivors. According to the data, 23.6 percent of survivors between the ages of 18 and 34 met the criteria of binge drinking compared to only 2.6 percent of those 75-and-older. This discrepancy also corresponded with cancer types more often associated with younger people, including cervical, testicular, head and neck cancers, and melanoma. Breast cancer survivors, in contrast, were less likely to drink.

Cancer, it seems, may exacerbate underlying issues. Participants who identified as excessive or binge drinkers may have had a pre-existing substance abuse issue prior to the cancer diagnosis and then it got exacerbated with the diagnosis and treatment. Or they may have had a propensity for substance use before their diagnosis—like through family history—and the cancer diagnosis put them over the edge. Less common, but still possible, is the development of substance abuse among people who didn’t have any risk factors for a substance abuse disorder, but developed it because they now have access to certain pain medications from their treatment.

Patients who are diagnosed with cancer and are using substances can actually negatively impact their treatment, symptom management, quality of life, and can contribute to increasing psychological suffering.

For physicians, the results of this survey serve as a call-to-action. While also a social act, excessive drinking can also be a sign of mental health issues. According to a 2014 report in the European Journal of Public Health, “Frequent binge drinking and alcohol problems are associated with poor mental health, especially with a lack of life satisfaction and psychological distress.”

Likewise, as reported in issue three of Cancer Wellness, mental health remains a critical, yet overlooked issue among cancer warriors and thrivers. According to a 2016 report from the journal Clinical Advances in Hematology & Oncology, “Psychiatric disorders are now recognized to occur in approximately 30% to 60% of patients who are newly diagnosed with various types of cancer.” And distress, which the International Psycho-Oncology Society and the Union for International Cancer Control now calls the “sixth vital sign,” is present in all patients with cancer. As the report states, “Evidence suggests that addressing psychosocial, emotional, and physical symptoms early in the cancer trajectory, through such steps as palliative care or psychological interventions may influence survival outcomes.” Miryam Yusufov, Ph.D., a clinical psychologist at the Dana Farber Cancer Institute and an instructor of psychiatry at the Harvard Medical School, agrees, adding, “Patients who are diagnosed with cancer and are using substances can actually negatively impact their treatment, symptom management, quality of life, and can contribute to increasing psychological suffering.”

Doctors should inquire about the social activities—including alcohol consumption—of their patients recovering from cancer. And their inquiries should not be a one-and-done situation, but rather an ongoing conversation between physician and patient to better the patient’s chances for survival and avoid recurrence. According to Yusufov, doctors should screen for substance use as well as a family history of any sort of substance use disorder, regardless of whether it’s alcohol or other substances. As well, certain mental health issues can correspond to increased likelihood of a substance use disorder, so doctors should also screen for anxiety, depression and other trauma symptoms. A screening may entail a semi-formal interview with a few questions, for example.

After performing a screening, if a physician feels concern for their patient, they should make a referral for their patient to a mental health profession who has expertise in substance use disorders. Doctors should try to frame the decision as a team-oriented approach to avoid worrying the patient.

And patients themselves should also remain cognizant of any changes in their behavior, especially if they did not have a history of substance use or abuse in their past. “If [you] have a family history of substance use disorder but [you’ve] never used any substances [yourself], [you should] be very vigilant around that,” says Yusov. “The cancer diagnosis will be what predisposes them to a substance use disorder.”

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