ImportanceSome individuals are predisposed to cancer based on their substance use history, and others may use substances to manage cancer-related symptoms. Yet the intersection of substance use disorder (SUD) and cancer is understudied. 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.ObjectiveTo describe the cancer type–specific prevalence of SUD among adult cancer survivors.Design, Setting, and ParticipantsThis cross-sectional study used data from the annually administered National Survey on Drug Use and Health (NSDUH) for 2015 through 2020 to identify adults with a history of solid tumor cancer. Substance use disorder was defined as meeting at least 1 of 4 Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for abuse or at least 3 of 6 criteria for dependence.Main Outcomes and MeasuresPer NSDUH guidelines, we made adjustments to analysis weights by dividing weights provided in the pooled NSDUH data sets by the number of years of combined data (eg, 6 for 2015-2020). The weighted prevalence and corresponding SEs (both expressed as percentages) of active SUD (ie, within the past 12 months) were calculated for respondents with any lifetime history of cancer and, in secondary analyses, respondents diagnosed with cancer within 12 months prior to taking the survey. Data were analyzed from July 2022 to June 2023.ResultsThis study included data from 6101 adult cancer survivors (56.91% were aged 65 years or older and 61.63% were female). Among lifetime cancer survivors, the prevalence of active SUD was 3.83% (SE, 0.32%). Substance use disorder was most prevalent in survivors of head and neck cancer (including mouth, tongue, lip, throat, and pharyngeal cancers; 9.36% [SE, 2.47%]), esophageal and gastric cancer (9.42% [SE, 5.51%]), cervical cancer (6.24% [SE, 1.41%]), and melanoma (6.20% [SE, 1.34%]). Alcohol use disorder was the most common SUD (2.78% [SE, 0.26%]) overall and in survivors of head and neck cancer, cervical cancer, and melanoma. In survivors of esophageal and gastric cancers, cannabis use disorder was the most prevalent SUD (9.42% [SE, 5.51%]). Among respondents diagnosed with cancer in the past 12 months, the overall prevalence of active SUD was similar to that in the lifetime cancer survivor cohort (3.81% [SE, 0.74%]). However, active SUD prevalence was higher in head and neck (18.73% [SE, 10.56%]) and cervical cancer survivors (15.70% [SE, 5.35%]). The distribution of specific SUDs was different compared with that in the lifetime cancer survivor cohort. For example, in recently diagnosed head and neck cancer survivors, sedative use disorder was the most common SUD (9.81% [SE, 9.17%]).Conclusions and RelevanceFindings of this study suggest that SUD prevalence is higher among survivors of certain types of cancer; this information could be used to identify cancer survivors who may benefit from integrated cancer and SUD care. Future efforts to understand and address the needs of adult cancer survivors with comorbid SUD should prioritize cancer populations in which SUD prevalence is high.

中文翻译：

---

美国成年癌症幸存者的药物使用障碍

重要性有些人因其物质使用史而容易患癌症，而另一些人可能会使用物质来控制与癌症相关的症状。然而，物质使用障碍 (SUD) 和癌症之间的交叉点尚未得到充分研究。由于 SUD 可能影响癌症护理并受其影响，因此识别 SUD 患病率高的癌症人群非常重要，目的是将注意力和资源引导到可能需要干预的群体和环境。 目的描述癌症类型特异性成人癌症幸存者中 SUD 的患病率。设计、背景和参与者这项横断面研究使用了 2015 年至 2020 年每年进行的全国药物使用和健康调查 (NSDUH) 的数据，以确定有实体瘤癌症史的成年人。物质使用障碍被定义为满足 4 项中的至少 1 项精神障碍诊断与统计手册（第四版）滥用标准或 6 个依赖标准中的至少 3 个。主要结果和措施根据 NSDUH 指南，我们通过将 NSDUH 汇总数据集中提供的权重除以合并数据的年数（例如，2015 年为 6 年）对分析权重进行了调整-2020）。针对有任何癌症终生病史的受访者，计算了活性 SUD（即过去 12 个月内）的加权患病率和相应 SE（均以百分比表示），并在二次分析中，计算了在服用 SUD 之前 12 个月内诊断出患有癌症的受访者该调查。数据分析时间为 2022 年 7 月至 2023 年 6 月。 结果本研究纳入了 6101 名成年癌症幸存者的数据（56.91% 年龄为 65 岁或以上，61.63% 为女性）。在终生癌症幸存者中，活动性 SUD 的患病率为 3.83%（SE，0.32%）。头颈癌（包括口腔癌、舌癌、唇癌、咽喉癌和咽癌；9.36% [SE, 2.47%]）、食管癌和胃癌（9.42% [SE, 5.51%]）的幸存者中物质使用障碍最为普遍。 ）、宫颈癌（6.24% [SE, 1.41%]）和黑色素瘤（6.20% [SE, 1.34%]）。总体而言，酒精使用障碍是头颈癌、宫颈癌和黑色素瘤幸存者中最常见的 SUD（2.78% [SE，0.26%]）。在食管癌和胃癌幸存者中，大麻使用障碍是最常见的 SUD（9.42% [SE, 5.51%]）。在过去 12 个月内诊断出患有癌症的受访者中，活动性 SUD 的总体患病率与终生癌症幸存者队列中的患病率相似（3.81% [SE, 0.74%]）。然而，头颈部 (18.73% [SE, 10.56%]) 和宫颈癌幸存者 (15.70% [SE, 5.35%]) 的活动性 SUD 患病率较高。与终生癌症幸存者队列相比，特定 SUD 的分布有所不同。例如，在最近诊断的头颈癌幸存者中，镇静剂使用障碍是最常见的 SUD（9.81% [SE，9.17%]）。结论和相关性本研究的结果表明，SUD 在某些类型癌症的幸存者中患病率较高; 该信息可用于识别可能受益于综合癌症和 SUD 护理的癌症幸存者。未来了解和满足患有 SUD 共病的成年癌症幸存者的需求的努力应优先考虑 SUD 患病率较高的癌症人群。