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Substance Abuse Issues In Cancer - Prevalence Among the Physically Ill

Substance abuse appears to be very uncommon among cancer patients. The reported prevalence of substance abuse issues in cancer patients is much lower than the prevalence in society at large, general medical populations, and emergency medical departments.[1,2,3,4,5] This relatively low prevalence was also reported in a Psychiatric Collaborative Oncology Group study, which assessed psychiatric diagnoses in ambulatory cancer patients from several tertiary care hospitals.[5] On the basis of structured clinical interviews, fewer than 5% of 215 cancer patients met the Diagnostic and Statistical Manual for Mental Disorders, 3rd Edition (DSM-III) criteria for a substance use disorder.[6]

The relatively low prevalence of substance abuse among cancer patients treated in tertiary care hospitals may reflect institutional biases or a tendency for patient underreporting in these settings. Drug abusers who are poor or feel alienated from the health care system may not seek care in tertiary centers. Those who are treated in these centers may not acknowledge a history of drug abuse. The low prevalence of drug abuse in cancer centers, therefore, may not represent the true prevalence among the cancer population overall. A survey of patients who were admitted to a palliative care unit found indications of alcohol abuse in more than 25% of these patients;[7] this, however, represents highly selected palliative care patients referred to a specialized inpatient unit.

Defining Abuse and Addiction in the Physically Ill

Epidemiologic studies and clinical management depend on an accepted, valid nomenclature for substance abuse and addiction. The pharmacologic phenomena of tolerance and physical dependence are commonly confused with abuse and addiction. Terminology is also strongly influenced by sociocultural considerations that may lead to the sending of mixed messages in the clinical setting. The definitions of addiction and abuse that are applied to patients who are physically ill have been developed from populations of addicts who do not have physical illnesses. The clarification of this terminology is an essential step in improving the diagnosis and management of substance abuse in the palliative care setting. The list below gives the proposed definitions for these terms.

Proposed Terminology for Substance Abuse

PHYSICAL DEPENDENCE: Pharmacologic property of some drugs defined solely by the occurrence of abstinence syndrome following abrupt dose reduction, discontinuation of dosing, or administration of a pharmacologic antagonist.
TOLERANCE: Diminishing of one or more of the drug effects (either favorable or adverse) that are caused by exposure to the drug; may be pharmacologic or the result of associative learning.
SUBSTANCE ABUSE: Use of a substance in a manner outside sociocultural conventions; according to this definition, all use of illicit drugs and all use of licit drugs in a manner not dictated by convention (e.g., according to physician's orders) is abuse.
ADDICTION: Commonly used term that does not appear in current psychiatric nosologies but can be taken to mean the aberrant use of a substance in a manner characterized by loss of control, compulsive or escalating use, preoccupation, and continued use despite harm.

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WebMD Public Information from the National Cancer Institute

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Last Updated: December 14, 2009

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