More than one-third of cancer survivors consume ‘hazardous’ levels of alcohol

In In The News by Barbara Jacoby

By: Jennifer Southall


Key takeaways:

  • An analysis of more than 15,000 cancer survivors showed nearly 78% self-reported current alcohol use.
  • Nearly 40% of self-reported drinkers engaged in hazardous drinking.

Alcohol consumption and potentially hazardous drinking behavior appeared common among cancer survivors and those undergoing cancer treatment, according to study results published in JAMA Network Open.

Further research is needed to address emerging concerns about adverse treatment and oncologic outcomes associated with alcohol consumption among cancer survivors, researchers concluded.

Rationale and methodology

“Little is known about how much survivors of cancer use alcohol, and whether that varies by type of cancer or prior treatments,” Noelle K. LoConte, MD, FASCO, associate professor of medicine at University of Wisconsin School of Medicine and Public Health and Carbone Cancer Center, told Healio. “Alcohol use during treatment is particularly risky, as alcohol can complicate cancer treatments, such as surgery, chemotherapy and radiation. “We sought to understand the ongoing use of alcohol among cancer survivors, as this could be an area that oncologists could target in survivorship care.”

LoConte and colleagues conducted a cross-sectional study using data from 15,199 adults (mean age at baseline, 63.1 years; 62.6% women) diagnosed with cancer included in the NIH All of Us Research Program between May 6, 2018, and Jan. 1, 2022.

The main outcome measures included prevalence of current drinking and risky drinking behaviors, including exceeding moderate drinking (more than two drinks on a typical drinking day), binge drinking (six or more drinks on one occasion) and hazardous drinking (defined as Alcohol Use Disorders Identification Test — Consumption [AUDIT-C] scores of 3 or more for women, or 4 or more for men).


Overall, 11,815 (77.7%) individuals in the cohort self-reported as current drinkers; of these, 13% exceeded moderate drinking, 23.8% reported binge drinking and 38.3% engaged in hazardous drinking.

Multivariable analysis revealed multiple factors associated with higher likelihood of exceeding moderate drinking levels. Results showed higher likelihood among individuals aged younger than 65 years (age < 50 years, OR = 2.9; 95% CI, 2.41-3.48; age 50 to 64 years, OR = 1.84; 95% CI, 1.58-2.15), men (OR = 2.38; 95% CI, 2.09-2.72), Hispanic individuals (OR = 1.31; 95% CI, 1.04-1.64), those diagnosed prior to age 18 years (OR = 1.52; 95% CI, 1.04-2.24) and ever-smokers (former smokers, OR = 2.46; 95% CI, 2.16-2.79; current smokers, OR = 4.14; 95% CI, 3.4-5.04).

Individuals diagnosed before age 18 years (OR = 1.52; 95% CI, 1.11-2.08) and those who ever smoked (former smokers, OR = 1.83; 95% CI, 1.68-1.99; current smokers, OR = 2.13; 95% CI, 1.79-2.53) also appeared more likely to engage in hazardous drinking.

In addition, among the 1,839 individuals undergoing cancer treatment, 76.4% self-reported as current drinkers; of these, 12.1% exceeded moderate drinking, 23.4% reported binge drinking and 38.4% engaged in hazardous drinking.

Researchers acknowledged study limitations.

For example, Dietary Guidelines for Americans 2020-2025 classifies exceeding moderate drinking as having more than one drink per day for women. However, the All of Us Research Program survey only allowed LoConte and colleagues to define exceeding moderate drinking for women as more than two drinks per day. In addition, the definition of binge drinking in the survey differed from that in the National Institute on Alcohol Abuse and Alcoholism guideline.

Also, the survey asked about average alcohol consumption in the prior year, and investigators used EHRs to obtain cancer treatment information during that same period. However, the exact timing of alcohol consumption in association with cancer treatment could not be established, LoConte and colleagues wrote.


The findings suggest that oncologists should ask all patients about alcohol use, regardless of whether they have an alcohol-associated cancer, LoConte told Healio.

“We know that when oncologists ask about substance use, patients are more likely to listen to their counsel about what amount of use is safe and recommended,” LoConte said.

“I continue to work in alcohol control as a way to prevent and diminish the burden of cancer,” she added. “[I] am currently working on a project with Darren Mays, PhD, MPH, associate professor and assistant dean for research and tenure track faculty at The Ohio State University College of Medicine, along with other collaborators in the Big Ten Cancer Research Consortium to explore messaging about cancer and alcohol to young adults to see if we can impact high risk alcohol consumption earlier in the life course.”