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The prevalence of substance use disorder (SUD) among adult cancer survivors varies depending on the particular cancer type, according to results from a cross-sectional study.

Among over 6,000 respondents to the National Survey on Drug Use and Health (NSDUH) for 2015 through 2020, SUD was most prevalent in survivors of head and neck cancer (9.36%), esophageal and gastric cancer (9.42%), cervical cancer (6.24%), and melanoma (6.2%), reported Devon K. Check, PhD, of Duke University School of Medicine in Durham, North Carolina, and colleagues.

Though the prevalence of active SUD -- about 4% -- was similar between lifetime cancer survivors and those recently diagnosed (within the past 12 months), active SUD prevalence was particularly high among patients with recent diagnoses of head and neck cancers (18.7%) and cervical cancer (15.7%), they noted in .

"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," Check and colleagues wrote. The study's results "highlight certain populations of cancer survivors who would likely benefit the most from such interventions based on their higher prevalence of SUD, including those with a lifetime history of and those with recently diagnosed cervical and head and neck cancers."

Alcohol use disorder was by far the most common disorder (2.8%) among lifetime cancer survivors, and was the most common SUD for cervical cancer, melanoma, and head and neck cancer survivors.

Check and colleagues observed that while opioid use disorder (OUD) and prescription sedative use disorder were generally uncommon (<1%) among survivors of all types of cancers, the prevalence of OUD and sedative use disorder was 1.4% and 1.8%, respectively, among head and neck cancer survivors. Of note, 9.8% of those with recently diagnosed head and neck cancer had sedative use disorder.

In survivors of esophageal and gastric cancers, cannabis use disorder was the most prevalent SUD (9.42%).

For this study, Check and colleagues used data from the NSDUH, which assesses SUD prevalence in the prior 12 months based on DSM-IV criteria and diagnostic interviews. The NSDUH began asking about cancer history in 2015, enabling the authors to use data from 2015-2020 to identify respondents who reported any lifetime history of solid tumor cancers.

The main study cohort included 6,101 adult cancer survivors with any lifetime cancer history. Of these survivors, 57% were 65 years or older, 62% were women, and 83% were white. The most common cancers were breast cancer (26%), prostate and testicular cancer (16%), and melanoma (8%). About one in five of the survivors had multiple cancers.

While breast cancer accounted for most of the cancers in this study, the prevalence of SUD among those survivors was just 2.6%.

Check and colleagues acknowledged that their findings on overall SUD prevalence was lower than that observed in previous reports of SUD among cancer survivors, and suggested this could be due to their specific definition of SUD (active SUD assessed using DSM-IV criteria and diagnostic interview), while prior reports "may have conflated substance use, substance misuse, and SUD."

The authors also pointed out that the NSDUH is believed to underestimate OUD. "Thus, estimates of OUD prevalence in the present study are likely underestimates," they suggested.

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