In a recent study published in JAMA Network Open, researchers characterized patterns of alcohol consumption among cancer survivors in the United States.
study: Alcohol consumption among adults diagnosed with cancer in the All of Us Research Program. Image credit: SkrypnykovDmytro/Shutterstock.com
Background
Alcohol consumption is causally linked to several types of cancer. It is also associated with adverse outcomes among cancer patients, such as the occurrence of new primary cancers, higher risks of recurrence and death.
However, specific monitoring and counseling are not available for cancer survivors who are advised to follow the American Cancer Society’s dietary and physical activity guidelines. However, less is known about patterns of alcohol intake among cancer survivors in the US.
About the research
In the current study, researchers comprehensively characterized patterns of alcohol consumption among cancer survivors in the US.
The study identified cancer survivors from All of Us, a large US research program that collects survey data (on personal medical history, lifestyle and overall health), electronic health records, biospecimens and physical measurements. Cancers were stratified as alcohol-related and non-alcohol-related. Age at cancer diagnosis was extracted.
Alcohol consumption status was determined according to lifestyle survey responses and classified as current, former, or never drinker. Former drinkers had at least one drink in their lifetime but not in the past year.
Current drinkers had at least one drink in the past year. Never drinkers reported not drinking alcoholic beverages. Additionally, risky drinking behavior has been characterized among current drinkers based on quantity and frequency of consumption.
Smoking status was also assessed and participants were categorized as never, former, or current smokers. Current smokers had smoked at least 100 cigarettes and continued to smoke every day or on some days. Former smokers had smoked at least 100 cigarettes but had quit. Never smokers have smoked at least 100 cigarettes in their lifetime.
The team identified cancer survivors whose first medical encounter occurred at least one year before the main study and those who had undergone cancer treatment in the year before the main study.
Treatment data were extracted and classified as chemotherapy, surgery, radiotherapy, hormone therapy, and immunotherapy. The authors calculated the crude prevalence of drinking and risky drinking behavior.
Odds ratios and 95% confidence intervals for current drinking and risk behaviors were estimated using multivariable logistic regression adjusted for sex, age at cancer diagnosis or study, ethnicity, race, marital status, education, household income, status of smoking, insurance status, cancer type, medications and treatment.
Among those who received treatment, prevalence estimates were stratified by type of treatment.
Findings
The study cohort consisted of 15,199 cancer survivors with a mean age of 63.1 years at baseline. Most subjects were female (62.6%) and non-Hispanic white (76.5%).
Over 75% of cancers are diagnosed in 18-64 year olds; most survivors (61.1%) had a college degree and high household income. About 6.6% of survivors were current smokers and 35.1% were ex-smokers. Most survivors (77.7%) were currently drinking.
Survivors of alcohol-related cancers who are non-Hispanic, white, without current medication or treatment are more likely to be current drinkers. Current and former smokers are more likely to be current drinkers.
Among current drinkers, 13% exceeded moderate drinking (more than two drinks in a typical sitting), and 23.8% reported binge drinking (more than six per occasion).
Survivors who were <65 years, male, Hispanic, and diagnosed with cancer 18 years ago were more likely to exceed moderate alcohol consumption and engage in binge drinking. About 38.3% of current drinkers engaged in hazardous alcohol use based on an Alcohol Use Disorders Identification Test (AUDIT-C) score ≥ 4 for males and ≥ 3 for females.
Survivors diagnosed with cancer before 18 years, as well as former and current smokers, were more likely to engage in hazardous drinking. About 1,839 cancer survivors received treatment within the year before the main study.
Of these, 76.4% were current drinkers, with similar prevalence estimates by type of cancer treatment; 12.1% exceeded moderate drinking, 329 engaged in binge drinking, and 540 exhibited hazardous drinking.
Conclusions
Taken together, the study showed that alcohol consumption was prevalent among cancer survivors; smokers, Hispanics, men, and those diagnosed with cancer before age 18 were more likely to exhibit risky drinking behaviors.
In addition, alcohol consumption and risk-taking behaviors are common even among those treated. Given the adverse outcomes associated with alcohol, further research is needed to address this emerging concern among survivors.