How Substance Use Impacts Cancer Care: Breaking the Stigma to Improve Patient Outcomes

Cancer can be physically and emotionally demanding. For some people, this can also put them at risk of substance use. May is the Mental Health Awareness month and in this article we break down how substance use can affect cancer outcomes and explore how stigma can get in the way of care. You’ll also learn how treatment approaches can better support patients managing both cancer and substance use.

Substance Use Is Often Overlooked in Cancer Care

As cancer treatments improve, more patients are living longer. However, mental health and substance use care often remain under-prioritized in oncology. There is a link between substance use and cancer that cannot be overlooked as it goes both directions. Meaning that substance use can increase the risk of certain cancers, and a cancer diagnosis can also trigger or worsen substance use as patients manage pain or emotional distress.

In one study from JAMA Oncology involving over 6,000 adult cancer survivors, 3.83% had an active substance use disorder (SUD), with alcohol use disorder being the most common at 2.78%. This matters because patients with a SUD may receive less effective pain management and face more challenges following their cancer treatment plans. These difficulties can reduce quality of life and lower the chance of recovery.

Why Cancer and Substance Use Often Overlap

A cancer diagnosis often brings physical pain, stress, anxiety, and depression. To cope, some patients turn to alcohol, smoking, or other substances. Pain is commonly treated with opioids, which can be effective but also carry a risk of developing opioid use disorder (OUD).

To read more about opioid use and pain in cancer, visit this article of HealthTree Research findings by clicking the button below. 

Managing Pain and Opioid Use for Myeloma Patients

Tobacco and alcohol are the most widely used substances that raise cancer risk.

• Tobacco causes about 30% of all cancer deaths, including 80% of lung cancer deaths. It is also linked to cancers of the mouth, throat, larynx, esophagus, stomach, colon, rectum, pancreas, liver, kidney, bladder, cervix, and even blood cancers. Tobacco not only increases the risk of cancer, but can also produce metabolic and circulation issues in the body that make receiving cancer treatment more challenging. 

• Alcohol is responsible for about 3.5% of cancer deaths. The risk is proportional to the intake; higher amounts over long periods pose a higher risk. For women, heavy use means more than 4 drinks per day or 8 per week. For men, it’s more than 5 drinks per day or 15 per week. Alcohol is processed by the liver and can interfere with the metabolism of other cancer treatments, increase the risk of worse side effects, and, in some cases, inactivate the medication. 

These facts are important because quitting tobacco and reducing alcohol use, even after a cancer diagnosis, can still lower future cancer risks and improve health.

Other Substances That Can Complicate Cancer Treatment and Health

Aside from tobacco and alcohol, the following substances are also frequently seen among patients and can interfere with treatment:

• Cannabis or marijuana is a natural opioid that can be synthesized into CBD. It can be prescribed by a doctor and administered under controlled conditions. Medical-grade marijuana has strict sanitary regulations and can be beneficial for many people. There is a risk of fungal infection of the lungs associated with marijuana produced in unofficial or unsanitary settings. You can read more about safe uses of cannabis and its risks from the American Thoracic Society here. 

• Anabolic steroids are the most commonly used drugs among athletes to improve physical performance and aesthetic appearance. These drugs interact with hormone cycles and can also have a negative impact on other organs such as the liver, the cardiovascular, central nervous, musculoskeletal, endocrine, and reproductive systems. It is important to note that anabolic steroids are different from the commonly used steroids in cancer treatments.

• Injection drugs, including heroin. These drugs are administered directly into the veins, and their use has risks besides addiction. They can cause vascular strokes, blood and tissue infections, and blood-transmitted diseases like hepatitis and HIV.
  Prolonged use can affect the main veins, limiting the option for intravenous cancer medications or increasing the need for longer hospital stays to monitor its applications. 

• Synthetic drugs, such as methamphetamine (“meth” or “crystal”) is associated with liver cancer and affects psychiatric and physical performance. It is a toxic chemical substance for multiple organs, including the heart, brain and other liver.

• Cocaine is a powder absorbed by the mucous membranes. While cocaine’s impact on cellular processes is not fully understood, researchers speculated that the drug might stimulate white blood cell activity and growth. This could potentially speed up the formation of genetic errors that could lead to cancer. Read more about the link of cocaine and cancer here. 

Each of these substances has harmful effects on the body in more than one way. For example, meth, heroine and cocaine are often mixed with other toxic chemicals and powders such as benzene, a known carcinogen. All of these substances, once they’ve entered the body, are processed for elimination, interfering with the proper functioning of organs and metabolism. When receiving cancer treatment, they can also interfere with the absorption and beneficial effects of the therapy. 

Challenges in Coordinating Cancer and SUD Treatment

Treating cancer and SUD at the same time is complex. Some medications used to treat SUD, like buprenorphine or methadone, can interfere with cancer pain treatments or may be stopped when patients begin cancer care. Conversely, untreated SUD can make it harder to manage symptoms or keep up with appointments.

Patients taking naltrexone for alcohol use disorder may not be able to use certain cancer pain treatments that act on the same parts of the brain.

How Does Stigma Affect People With Substance Use Disorders?

Patients with past or current substance use may fear judgment or treatment changes if they disclose their use. This stigma can prevent honest conversations with their medical team. Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment. 

Stigma remains a major barrier. Some healthcare providers are not trained to manage SUDs in cancer patients, leading to missed opportunities for care. Stigmatizing language and views can negatively influence health care provider perceptions of people with SUD, which can impact the care they provide.

Reducing Stigma and Improving Support

One approach that has shown great results is harm reduction. This means supporting patients in reducing risky behaviors without judgment. For example, rather than requiring someone to fully quit a substance, providers can offer ways to reduce harm while continuing cancer treatment. These can include safer use tips, mental health support, or starting SUD treatment when the patient is ready.

When harm reduction strategies are used with all patients, stigma can be reduced, and more people feel safe sharing their needs.

The way we name things impacts stigma around substance use disorders 

There is a story behind every person, some wording perceived as popular, common or “harmless” can stigmatize people living with substance use disorders and prevent them for receiving the care they need. Reducing the stigma can start with simple things such as how we name things. 

Chart from Addiction in Patients With Cancer: Challenges and Opportunities 

Sourced from National Institute on Drug Abuse (2020)

Moving Toward More Inclusive, Effective Cancer Care

Patients with cancer who also use substances deserve care that addresses all aspects of their health. Integrating addiction services into cancer centers and training oncology providers in harm reduction and substance use management are important next steps.

Better education, open communication, and a compassionate approach can improve outcomes and make sure no patient feels left behind. Substance use is not a failure; it’s a health issue that deserves understanding and treatment, especially during cancer care.

Stay tuned for more articles at the HealthTree News Site, where we publish a wide variety of topics, from conference updates to treatment innovations. Click the button below to keep reading more articles. 

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For more information and help for people with substance use disorders, you can visit the following assistance resources: 

SAMHSA - Substance Abuse and Mental Health Services https://www.samhsa.gov/ 

Medication Assistance Therapy Care Clinic  https://www.matcareclinics.com/ 

American Addiction Centers https://drugabuse.com/addiction/health-issues/cancer/ 

CDC Mental Health Resources  https://www.cdc.gov/mental-health/caring/index.html#:~:text=Key%20points,to%20the%20nearest%20crisis%20center. 

American Society of Addiction Medicine https://www.asam.org/ 

Start Your Recovery Organization https://startyourrecovery.org/experiences/co-occurring-disorders 

Sources: 

• Drug and Alcohol Misuse and Cancer Risk
• Substance Use Disorders Among US Adult Cancer Survivors 
• Addiction in Patients With Cancer: Challenges and Opportunities
• Care for patients with cancer and substance use disorders: a qualitative study of oncology team experiences