Risky Drinking Behavior Common Among Cancer Survivors, Even During Treatment

Nearly four in 10 cancer survivors who drank alcohol engaged in risky drinking behaviors, a large retrospective study showed.

Overall, 38.3% of survivors who reported current alcohol use met validated criteria for hazardous drinking. The data also showed that almost 15% of the patients exceeded an accepted definition of moderate alcohol consumption, and almost a fourth acknowledged binge drinking. Patients who had a cancer diagnosis before age 18 and those who had ever smoked were more likely to report hazardous drinking.

“This cross-sectional study of a diverse U.S. cohort suggests that alcohol consumption and risky drinking were common among cancer survivors, even among individuals receiving treatment,” wrote Yin Cao, ScD, MPH, of Washington University in St. Louis, and co-authors in JAMA Network Open. “Given the short- and long-term adverse treatment and oncologic outcomes associated with alcohol consumption, additional research and implementation studies are critical to address this emerging concern among cancer survivors.”

Alcohol consumption has a causal relationship with multiple types of cancer and is associated with adverse outcomes in patients with cancer. In 2017, the American Society of Clinical Oncology cited a need to prioritize alcohol consumption as a key modifiable behavioral risk factor for cancer control research. Nonetheless, no specific guidelines for surveillance and counseling about alcohol use have been developed for cancer survivors, the authors noted.

Understanding alcohol use among cancer survivors remains limited by lack of evidence. One recent study showed that 35% of cancer survivors who reported current drinking exceeded moderate drinking limits (more than one drink per day for women and more than two for men), and 21% engaged in binge drinking (five or more drinks on one or more occasions in the past year).

“However, to our knowledge, patterns of drinking, including frequency as well as the co-occurrence of multiple risky drinking behaviors, have not been described,” the authors continued.

To gain more insight into alcohol consumption behavior among cancer survivors, Cao and colleagues queried the NIH All of Us Research Program database, a diverse U.S. cohort with electronic health record (EHR) linkage, for data collected from May 2018 to January 2022. The cohort included 15,199 participants who reported a cancer diagnosis, including a subgroup of 1,839 with EHR data relative to cancer treatment within the past year.

The primary outcomes were prevalence of current drinking and risky drinking behaviors, defined as:

• Exceeding moderate drinking: more than two drinks on a typical drinking day
• Binge drinking: six or more drinks on at least one occasion
• Hazardous drinking: Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score ≥3 for women, ≥4 for men

The study population had a mean age of 63.1, and women accounted for 62.6% of the participants with a cancer diagnosis. The data showed that 77.7% of participants were current drinkers. Among those, 13% exceeded moderate drinking, 23.8% reported binge drinking, and 38.3% met AUDIT-C criteria for hazardous drinking.

Multivariable analysis yielded higher odds ratios for exceeding moderate drinking among patients with the following characteristics: age <65 (OR 1.84-2.90), male sex (OR 2.38), Hispanic ethnicity (OR 1.31), age <18 at cancer diagnosis (OR 1.52), former smoking (OR 2.46), and current smoking (OR 4.14). Binge drinking was more common among the same subgroups: age <65 (OR 2.15-4.46), men (OR 2.10), Hispanic ethnicity (OR 1.31), age <18 at cancer diagnosis (OR 1.71), former smokers (OR 1.69), and current smokers (OR 2.13).

The numbers were similar in the subgroup of patients currently receiving treatment for cancer.

“Our study extends the scope of prior understanding through using a diverse U.S. cohort to characterize risky drinking behaviors comprehensively among cancer survivors,” Cao and team wrote. “More important, by linking with EHR data to annotate treatment information, we found that drinking and risky drinking behaviors are prevalent even among individuals concurrently receiving treatment for cancer.”

“Alcohol consumption and risky drinking behaviors among cancer survivors are associated with various adverse long-term outcomes, including higher risk of recurrence, secondary primary tumors, and increased mortality,” they added. “More studies are warranted to elucidate the role of each risky drinking behavior and the overall pattern in long-term outcomes.”

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