Conversations with cancer survivors about alcohol use may need to be more frank, as new research is offering very sobering news about alcohol and cancer. In the first large study on drinking habits of cancer survivors, researchers found more than one-third exceed moderate drinking levels, and 1 in 5 engage in binge drinking.

The researchers used data from the National Health Interview Survey (NHIS) from 2000 to 2017 to examine self-reported drinking habits. Among the 34,080 cancer survivor survey participants, 56.5% were current drinkers, 34.9% exceeded moderate drinking levels, and 21% engaged in binge drinking. This study defined excessive drinking as more than 1 drink a day for women and more than 2 drinks a day for men, per current guidelines from the Centers for Disease Control and Prevention (CDC). Binge drinking was defined as consuming enough alcohol to raise blood alcohol content to at least .08% (approximately 4 drinks within 2 hours for women and at least 5 for men).

“The most surprising finding was the overall high prevalence of alcohol use among cancer patients and survivors,” said study investigator Nina Niu Sanford, MD, assistant professor, Dedman Family Scholar in Clinical Care, UT Southwestern Medical Center, Department of Radiation Oncology, Dallas, Texas. “Since this is the first large study of alcohol use in the oncology population, we had no prior data to compare our findings with; however, we thought that the prevalence of alcohol use might have been lower.”

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Studies have shown that alcohol can be a risk factor for several cancers and so these findings suggest greater education efforts are needed. Dr Sanford suggested screening for alcohol use at regular intervals plus providing resources to assist in cutting down use for those who may engage in excessive drinking behaviors. “Oncology nurses first need to ask patients about alcohol use in a manner that is nonjudgmental and provide them with time to discuss concerns, if any,” she said. Alcohol use is usually recorded as part of a patient’s social history but often asked about just once, when the patient first enters the medical system. Their response is copied forth in subsequent notes, even though drinking behaviors can change, particularly as patients transition from active care to survivorship, Dr Sanford explained to Oncology Nurse Advisor

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Who’s at Risk?

Certain demographics were associated with higher odds of binge drinking, and so providers should pay special attention to these patient groups, Dr Sanford advised. Several variables were found to be associated with binge drinking, including male sex, better health status, younger age, Alaska Native/American Indian race, higher income, and former or current smoker.

The researchers found that binge drinking rates were much higher for younger cancer survivors, with 23.6% of survivors aged 18 to 34 meeting the criteria for binge drinking. Only 2.6% of those aged 75 and older met the binge-drinking criteria. Survivors of cervical, testicular, and head and neck cancers and melanoma were more likely to report drinking at all levels. The data showed drinking was much less common for survivors of breast cancer.

Somewhat paradoxically, the researchers also found that better self-reported health correlated to more drinking. Study investigator Brandon A. Mahal, MD, of the McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, said these results point to a need for more research on alcohol use in all subsets of cancer survivors, perhaps with an emphasis on reducing alcohol use in patients who feel well and report excessive drinking. “The biggest concern is that alcohol intake is a risk factor for cancer development, and could also lead to worse outcomes or greater treatment toxicity in people with cancer,” said Dr Mahal.

Oncology nurses, physicians, and other health care providers can help by regularly screening for alcohol use and also providing counseling, support, and resources to assist patients with addressing behaviors that lead to excessive drinking. “Of all health care providers, patients are most likely to trust nurses, and therefore oncology nurses are very well-positioned to help address these risky behaviors,” Dr Mahal told Oncology Nurse Advisor.