Substance Use Disorder Among Current Cancer Patients : Rates and Correlates Nationally in the Department of Veterans Affairs

Abstract: Background: Substance use disorders (SUDs) are known to cause or complicate treatment of many types of cancers. Objectives: We sought to systematically assess rates of current SUDs among patients currently in treatment for cancer. Methods: The National Veteran Health Administration administrative data from fiscal year 2012 were used to compare veterans with both cancer and comorbid SUDs to veterans with cancer but no SUDs and those with a SUD but no cancer. Bivariate comparisons and multivariate logistic regression were used to compare groups on sociodemographic characteristics, medical and mental health diagnoses, service use, and psychotropic and opioid medication fills. Results: Of 482,688 veterans with cancer diagnoses, 32,037 (6.64%) had a comorbid SUD diagnosis. Veterans with cancer and a SUD had more medical and psychiatric disorders than those with cancer alone, a greater risk of homelessness, and a greater use of both mental and medical health services, with 60% receiving mental health outpatient treatment. These veterans had fewer differences from veterans with SUDs only, although they were older and had more medical illnesses. Notably the cancer SUD group had higher rates of hepatic disease and received a greater number of opioid prescriptions than both veterans with cancer alone and veterans with SUD alone. Conclusions: Veterans with cancer and SUD showed a specific risk for liver disease and a higher use of opioids. Collaborative teams involving oncology, palliative care, and psychiatry may be best able to address the challenge of providing adequate and safe opiate pain control for this vulnerable population.