Alcohol consumption is a topic of considerable interest in the context of cancer survivorship, posing various implications for individuals who have overcome cancer. Alcohol, recognized for its carcinogenic properties, is implicated in the increased likelihood of developing several cancer types. For those who have overcome cancer, the concern is how alcohol might affect their chances of remaining cancer-free or potentially facing new cancer challenges in the future. Research indicates that even moderate drinking could tweak the risk for these survivors, leading healthcare professionals to advocate for caution or total abstinence.
Previous inquiries into how cancer survivors engage with alcohol sometimes lacked temporality in self-reported data, making it tough to pinpoint when alcohol was consumed in relation to the cancer diagnosis. Moreover, the focus on certain cancer types meant we did not have a full picture of drinking behaviors across a diverse array of cancer experiences and survivors. Dr. Heffner, an associate professor in the Public Health Sciences Division, and her team set out to fill these gaps, aiming to provide a more detailed and accurate understanding of alcohol consumption among cancer survivors, especially during the early days of the COVID-19 pandemic.
Their study published in Cancer Epidemiology, Biomarkers & Prevention, examines how common alcohol consumption is among cancer survivors in the Puget Sound Surveillance Epidemiology and End Results (SEER) region, aiming to identify the personal, behavioral, and clinical characteristics associated with varying levels of drinking. The SEER program collects cancer incidence and survival information from various regions in the United States, and is used for research, public health policy, and resource allocation to improve cancer prevention, diagnosis, treatment, and care.
The study focused on cancer survivors aged between 21 and 74 at diagnosis, focusing on those with invasive cancer, 6 to 17 months post-diagnosis. This specific population was selected to provide insights into alcohol consumption patterns among cancer survivors during the early COVID-19 pandemic, aiming to reduce memory bias and the diverse impacts of the pandemic on alcohol use. Out of the 10,710 survivors who were contacted, 1,479 individuals completed the surveys. The participants included in the study were predominantly over 55, female, and married or in a similar partnership, with incomes above $75,000 and education beyond high school. The most common cancer types reported were breast and prostate cancers, mostly at localized stages, which paints a picture of the participants’ health landscape. A notable segment reported using substances like nicotine, opioids, and cannabis after their diagnosis, adding layers to their health narratives.
The study's findings are striking: 71% of the participants reported drinking alcohol post-diagnosis. The likelihood of consuming alcohol post-diagnosis was higher among individuals with a sexual and gender minority identity, those earning an annual income of $100,000 or more, and those who used cannabis but did not meet the criteria for a cannabis use disorder. Moreover, the concerning finding that 46.2% of participants drank beyond cancer prevention guidelines, coupled with a 31.6% rate of hazardous drinking, calls for a concerted effort to craft interventions that resonate with the unique needs of cancer survivors.
This research sheds essential light on the alcohol consumption behaviors of cancer survivors, showing a significant portion engages in drinking after their diagnosis, often exceeding recommended cancer prevention guidelines. The findings underscore the need for proactive strategies in cancer care settings to identify and address risky alcohol use, which is particularly important given the study's context during the early stages of the COVID-19 pandemic—a factor that may have influenced these behaviors.
However, the study is not without limitations, including a modest response rate and questions about how well the sample represents the wider population due to limited demographic and economic data. The cross-sectional nature and pandemic timing also make it challenging to draw long-term conclusions or establish cause-and-effect relationships. Despite these limitations, the study emphasizes the critical need for integrated support within cancer care to tackle alcohol use, spotlighting a key aspect of survivorship care that demands attention and action to enhance health outcomes for cancer survivors.
This research has led to a promising new project to develop an electronic screening, brief intervention, and referral to treatment (e-SBIRT) program for alcohol consumption among breast cancer survivors, financed by Fred Hutch survivorship pilot grants. “We are currently developing the program with the help of a team of patient advocates, who are helping us understand patients’ needs and preferences around information and support for changing alcohol use. The other investigators on that project are Heather Greenlee, Rachel Yung, and Ty Lostutter,” says Dr. Heffner.
This study received support through grants from the National Cancer Institute (NCI) and the National Institutes of Health (NIH).
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Members Dr. Jaimee Heffner contributed to this study.
Heffner, J. L., Ton, M., Jones, S. M. W., Malen, R. C., Cohen, S. A., & Newcomb, P. A. (2024). Prevalence and correlates of post-diagnosis alcohol use among cancer survivors. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 10.1158/1055-9965.EPI-23-1155. Advance online publication.