Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
Department of Psychiatry, VISN I Mental Illness Research Education Clinical Center (MIRECC), VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, CT.
Psychosomatics. 2018 May-Jun;59(3):267-276. doi: 10.1016/j.psym.2018.01.003. Epub 2018 Jan 10.
Substance use disorders (SUDs) are known to cause or complicate treatment of many types of cancers.
We sought to systematically assess rates of current SUDs among patients currently in treatment for cancer.
The National Veteran Health Administration administrative data from fiscal year 2012 were used to compare veterans with both cancer and comorbid SUDs to veterans with cancer but no SUDs and those with a SUD but no cancer. Bivariate comparisons and multivariate logistic regression were used to compare groups on sociodemographic characteristics, medical and mental health diagnoses, service use, and psychotropic and opioid medication fills.
Of 482,688 veterans with cancer diagnoses, 32,037 (6.64%) had a comorbid SUD diagnosis. Veterans with cancer and a SUD had more medical and psychiatric disorders than those with cancer alone, a greater risk of homelessness, and a greater use of both mental and medical health services, with 60% receiving mental health outpatient treatment. These veterans had fewer differences from veterans with SUDs only, although they were older and had more medical illnesses. Notably the cancer SUD group had higher rates of hepatic disease and received a greater number of opioid prescriptions than both veterans with cancer alone and veterans with SUD alone.
Veterans with cancer and SUD showed a specific risk for liver disease and a higher use of opioids. Collaborative teams involving oncology, palliative care, and psychiatry may be best able to address the challenge of providing adequate and safe opiate pain control for this vulnerable population.
物质使用障碍（SUD）已知会导致或使许多类型癌症的治疗复杂化。
我们旨在系统评估当前正在接受癌症治疗的患者中当前 SUD 的发生率。
使用国家退伍军人健康管理局 2012 财年的行政数据，将同时患有癌症和合并 SUD 的退伍军人与仅患有癌症而无 SUD 的退伍军人以及患有 SUD 而无癌症的退伍军人进行比较。使用双变量比较和多变量逻辑回归比较组间的社会人口统计学特征、医疗和心理健康诊断、服务使用情况以及精神药物和阿片类药物的使用情况。
在 482688 名患有癌症诊断的退伍军人中，有 32037 名（6.64%）患有合并 SUD 诊断。患有癌症和 SUD 的退伍军人比仅患有癌症的退伍军人有更多的医疗和精神障碍，无家可归的风险更高，对精神和医疗保健服务的使用更多，有 60%接受精神健康门诊治疗。这些退伍军人与仅患有 SUD 的退伍军人相比，虽然年龄更大且患有更多的疾病，但差异较小。值得注意的是，癌症 SUD 组的肝脏疾病发生率更高，并且开出的阿片类药物处方数量多于仅患有癌症和仅患有 SUD 的退伍军人。
患有癌症和 SUD 的退伍军人表现出肝脏疾病的特定风险和更高的阿片类药物使用。涉及肿瘤学、姑息治疗和精神病学的协作团队可能最有能力为这一弱势群体提供充分和安全的阿片类药物疼痛控制。
