Substance Use Disorders Among Cancer Survivors

Abstract

To the Editor Jones and colleagues 1 should be commended for raising concerns about substance use disorders among adult cancer survivors. Indeed, this is a major comorbidity that impairs prognosis, and certainly there is room for improving its assessment and treatment: the PubMed search "substance use disorder and cancer" only retrieved 270 articles.However, it should not be forgotten that tobacco use is the most common substance use disorder in the US and globally. This oblivion is too frequent: only 75% of oncologists assess tobacco use at the intake visit, 60% advise patients to quit despite the fact that smoking seriously affects outcomes (eg, cancer treatment effectiveness, overall survival, risk of second primary malignant neoplasms, quality of life). 2 Furthermore, current tobacco use is associated with a range of other substance use and mental health problems; these relationships persist after accounting for a range of confounding variables. The presence of these other problems needs to be considered because they are likely to reduce the success of attempts to quit smoking. 3 Similarly, e-cigarette use is a growing concern among patients with cancer; 4 even more so, as there is accumulating evidence that e-cigarettes should be assessed by the International Agency for Research on Cancer (IARC) and classified as a group 2A agent (probably carcinogenic) or a group 2B agent (possibly carcinogenic). 5