Researchers have reported ahead of print that substance use disorders may adversely affect outcomes in men with advanced prostate cancer This conclusion was drawn from a very large study of 14,277 men with advanced prostate cancer.

The study found that men with advanced prostate cancer along with a substance abuse 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 men without a substance abuse disorder.

The researcher, 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.

They found that the 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.

On the economic side they found that compared with men who did not have a substance use disorder, those men with a disorder had 70% higher costs.

Given this finding and considering that many states in the United States have continued to liberalize the marijuana laws we might be seeing the emergence of an even bigger issue in the our treatment.

More attention needs to be paid by the medical community and the families of men with advanced prostate cancer when the men have any sort of substance abuse problems. Substance abuse issues cause unique challenges to the delivery of effective and efficient care. The family, the man and his treating physicians must acknowledge substance abuse so that proper treatment for the disorder can be incorporated as a part of the actual cancer treatment. Due to the significant problem for effective care doctors should now consider regular and on-going drug abuse screening for all prostate cancer patients.

Joel T. Nowak, M.A., M.S.W.