Researchers Surprised by High Levels of Alcohol Consumption among Cancer Survivors

PLYMOUTH MEETING, PA [January 8, 2020] — New research in the January 2020 issue of JNCCN—Journal of the National Comprehensive Cancer Network uses data from the National Health Interview Survey (NHIS) from 2000 to 2017 to examine self-reported drinking habits among people reporting a cancer diagnosis. The researchers found that of 34,080 survey participants, 56.5% were current drinkers, 34.9% exceeded moderate drinking levels, and 21% engaged in binge drinking. This is the first large study to be done on alcohol use in the oncology population. Given that alcohol has been identified as a risk factor for several cancers[1] (and contributed to 5.8% of cancer deaths in 2012[2]), the researchers were surprised by how high those numbers were.

“We recommend that providers screen for alcohol use at regular intervals and provide resources to assist in cutting down use for those who may engage in excessive drinking behaviors,” said Nina Niu Sanford, MD, Assistant Professor, Dedman Family Scholar in Clinical Care, UT Southwestern Medical Center, Department of Radiation Oncology. “Typically, questions about alcohol use are just asked once when the patient first enters the medical system and then copied into subsequent notes as part of the patient’s social history.”

For the purposes of the study, excessive drinking was defined as more than one drink a day for women, and more than two drinks a day for men, per CDC guidelines.[3] Binge drinking was defined in the same guidelines as consuming enough alcohol to raise blood alcohol content to at least .08%, which generally means at least four drinks within two hours for women, and at least five for men. For this study, the researchers defined binge drinking as the consumption of at least five drinks in one day at any point over the past year. The authors noted that there aren’t currently studies that establish safe levels of alcohol use when it comes to cancer risk, but studies have suggested the risk is higher for people who engage in binge drinking.

Further examination of the data showed binge drinking rates were much higher for younger survivors. Among those age 18 to 34, 23.6% met the criteria for binge drinking, while only 2.6% of those 75-and-older reported the same. Likewise, survivors of cancer types that are more associated with younger people—like cervical, testicular, head and neck cancers, and melanoma—were more likely to report drinking at all levels, while drinking was much less common for survivors of breast cancer. Somewhat paradoxically, the researchers also found that better self-reported health correlated to more drinking.

“We would hypothesize that individuals with a diagnosis of cancer who self-report poor health status may be those with persistent or recurrent disease who are undergoing active treatment, or experiencing persistent side effects from prior treatment, and therefore may have been advised not to drink or don’t feel well enough to consume alcohol,” said Brandon A. Mahal, MD, McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute. “However, since causation cannot be established from the NHIS survey, another possibility could be that alcohol use improved the overall self-reported health among cancer survivors, although we think this is less likely. These results point to the fact that more research on alcohol use is needed for all subsets of survivors of cancer, perhaps with an emphasis on reduction in patients who feel well and report excessive drinking.”

Crystal S. Denlinger, MD, FACP, Chief, GI Medical Oncology, Fox Chase Cancer Center, chairs the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) Panel for Survivorship. She was not involved in this study, but commented on the importance of more research into the impact of alcohol use among cancer survivors.

“This study highlights the prevalence of current alcohol use among cancer survivors, including an increase in alcohol intake over time and higher rates among younger cancer survivors,” said Dr. Denlinger. “As alcohol intake is a risk factor for cancer development and may contribute to worse outcomes following a diagnosis, this behavior is ripe for education and intervention in the survivor population. Currently guidelines for the care of cancer survivors, including the NCCN Guidelines for Survivorship, recommend limiting the intake of alcohol. Further work to understand optimal dissemination of these recommendations and ways to change alcohol use behavior is clearly needed in the cancer survivor population, particularly among younger survivors.” 

Notably, the researchers also found that 16.7% of cancer survivors self-reported as current smokers. Both current and former smokers were more likely to report themselves as current drinkers. The researchers recommend that survivors also be screened for smoking, and then counseled on both smoking and drinking-related health issues, and offered cessation support. 

To read the entire study, visit JNCCN.org. Complimentary access to “Alcohol Use Among Patients With Cancer and Survivors in the United States, 2000-2017” is available until April 10, 2019.

 [1] Van’t Veer P, Kampman E. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. World Cancer Research Fund/American Institute for Cancer Research; 2007.

[2] Praud D, Rota M, Rehm J, et al. Cancer incidence and mortality attributable to alcohol consumption. Int J Cancer 2016;138:1380-1387

[3] Centers for Disease Control and Prevention. Alcohol and public health: frequently asked questions. Available at cdc.gov/alcohol/faqs.htm. Accessed July 30, 2019.

About JNCCN—Journal of the National Comprehensive Cancer Network

More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.aspx. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network^® (NCCN^®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.

The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCN, Facebook @NCCNorg, and Instagram @NCCNorg.

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