Substance Abuse May Worsen Advanced Prostate Cancer Outcomes

More likely to be hospitalized and to make emergency department visits.
More likely to be hospitalized and to make emergency department visits.

Substance use disorders may adversely affect outcomes in men with advanced prostate cancer (PCa), researchers reported online ahead of print in Cancer.

In a study of 14,277 men with advanced PCa, those who were diagnosed with a substance use disorder were 2.3 times more likely to be hospitalized, 2.6 times more likely to make an outpatient hospital visit, and 1.7 times more likely to make an emergency department visit than patients without a such a disorder.

For the study, Sumedha Chhatre, PhD, and colleagues at the University of Pennsylvania in Philadelphia, analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. They identified individuals who had a claim for substance use disorder in the year before their cancer diagnosis (pretreatment phase), 1 year after the diagnosis (treatment phase), and an additional 4 years after diagnosis (follow-up phase). Of the 14,277 men, 1,509 (10.6%) had a substance use disorder as defined using the International Classification of Diseases (ICD-9). These disorders included alcoholic psychosis and related, drug psychoses and related, alcohol dependence syndrome, drug dependence, and non-dependent use of drugs.

Substance abuse disorder in the follow-up phase was associated with a 2-fold greater likelihood of hospitalization or hospital outpatient visit and a 1.7-fold greater likelihood of an emergency department visit.

In addition, compared with men who did not have a substance use disorder, those who did had 70% higher costs. During the follow-up phase, they had 60% higher costs.

The authors concluded that substance use disorder among Medicare patients with PCa “can pose unique challenges to the delivery of effective and efficient care. Substance use disorder can be multifaceted and chronic; therefore, it demands intense management similar to that for cancer.” Dr. Chhatre's group added that there is an urgent need to ascertain the missed opportunities for identifying and treating substance use disorder among elderly PCa patients. “As a first step, guidelines for prostate cancer care can incorporate screening for substance use disorder as a recommendation,” they wrote.

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