Trends, timing, and predictors of alcohol use disorder treatment among US adult cancer survivors

Abstract

Background: Little is known about the initiation of alcohol use disorder (AUD) treatments among cancer survivors, despite the unique harms that unhealthy alcohol use may have on this population. We assessed patterns, timing, and predictors of AUD treatment among cancer survivors.

Methods: We used commercial claims data on US adult cancer survivors from 2011 to 2021 in this retrospective cohort study. We included individuals with a new AUD diagnosis and continuous insurance enrollment. We measured initiation and timing of Food and Drug Administration (FDA)-approved (naltrexone, acamprosate, and disulfiram), non-FDA-approved (gabapentin, topiramate, and baclofen), and investigational (ondansetron and varenicline) medications for AUD (MAUDs), psychosocial therapies, and rehabilitation for AUD. We employed survival analysis to identify sociodemographic and clinical predictors of time to AUD treatment initiation.

Results: Among 6,682,292 cancer survivors, 44,081 individuals newly diagnosed with AUD met the inclusion criteria. Of these, 14.7% initiated FDA-approved MAUDs (3.0%), psychosocial therapy (13.0%), or both (1.3%). The median time to initiate FDA-approved MAUD or psychosocial therapy was 28 days. Overall, 6.3% and 10.4% of cancer survivors, respectively, initiated non-FDA-approved and investigational MAUDs. Age, use of antineoplastic agents, mental disorders, and comorbidity severity are potential determinants with varying effects on AUD treatment initiation.

Conclusion: Less than 15% of cancer survivors initiated recommended MAUDs or psychosocial therapy in the year following their new AUD diagnoses, and those who did initiate treatment did so nearly a month after receiving AUD diagnoses. Interventions are warranted to enhance treatment initiation among cancer survivors with AUD to reduce alcohol-related harms.

Keywords: AUD treatment; alcohol use disorder; cancer survivorship; cohort study; substance use disorder.