Substance Use Screening Protocol: Implementation of a System for Patients With Cancer

Receipt of Alcohol Screening, Brief Intervention, and Treatment Among US Adults With and Without a History of Cancer

PURPOSE

Many cancer survivors consume alcohol above recommended limits, increasing their risk of recurrence, second cancers, and cancer-related mortality. Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a guideline-recommended strategy for reducing unhealthy alcohol consumption among adult primary care patients. To our knowledge, no prior studies have evaluated SBIRT's reach among cancer survivors.

METHODS

We conducted a cross-sectional study of adults who completed the National Survey on Drug Use and Health from 2015 to 2022. We examined past-year receipt of alcohol screening and-among respondents who endorsed unhealthy alcohol use-brief intervention and treatment. All outcomes were examined among cancer survivors and those with no cancer history. We used modified Poisson regression to assess the associations of cancer history with each outcome, adjusting for sociodemographic characteristics.

RESULTS

The cohort included 86,410 respondents with no history of cancer and 9,963 cancer survivors. The percentages of respondents endorsing past-year receipt of alcohol screening (approximately 40%), brief intervention (approximately 8%), and treatment (approximately 2%) were similarly low in both groups. After adjustment, there was a small but statistically significant difference in alcohol screening, with cancer survivors more likely than people without a history of cancer to receive alcohol screening (adjusted risk ratio [aRR], 1.07; 95% CI, 1.02 to 1.13). Among those with unhealthy alcohol use, cancer survivors were no more or less likely than people without a history of cancer to receive brief alcohol intervention (aRR, 1.00; 95% CI, 0.93 to 1.07) or alcohol treatment (aRR, 0.92; 95% CI, 0.47 to 1.69).

CONCLUSION

Results reveal an important opportunity to improve SBIRT uptake across the board and especially for cancer survivors, who are at increased risk of alcohol-related adverse health effects and, potentially, more motivated to change cancer-related health behaviors.

Implementation of a Perinatal Substance Use Screening Protocol in the Outpatient Setting

OBJECTIVE

To implement the 5Ps Screen for Alcohol/Substance Use tool and the screening, brief intervention, and referral to treatment (SBIRT) process into clinical practice to determine if enhanced training would improve perinatal providers' adherence to universal screening.

DESIGN

A quality improvement project using a pre- and postintervention design.

SETTING/LOCAL PROBLEM

Three community-based, outpatient obstetrics and gynecology clinics in southeastern Massachusetts. The local problem identified was that no validated screening tool was being used for universal screening of substance use in pregnancy.

INTERVENTIONS/MEASUREMENTS

Training consisted of two phases that reviewed the SBIRT process, the 5Ps screening tool, brief intervention conversations, and the process for referral to treatment. Pre- and postimplementation screening rates were compared and analyzed using descriptive statistics and chi-square tests of independence.

RESULTS

Preimplementation screening rates were 14.4%. Screening rates measured 1 month after implementation were 44.6% (p < .001). Universal screening was not achieved.

CONCLUSION

Short-term improvement in screening for perinatal substance use was observed. Whether these results are sustainable beyond the project time frame is unknown. Future work should examine longer-term outcomes and continued barriers to universal uptake of the screening protocol.

Investigating documentation of alcohol and non-medical substance use in oncology treatment: an electronic health record review

PURPOSE

Little is known about non-tobacco substance use (SU) and its treatment in cancer patients. National guidelines address tobacco only, and assessment of SU in cancer patients is not standardized. It is not clear how oncology clinicians assess, document, and follow-up on SU.

METHODS

We conducted an electronic health record review of patients enrolled in a smoking cessation trial at one large hospital site (N = 176). Chart review of oncology treatment notes assessed whether SU assessment was documented, the content of the documentation/assessment (e.g., frequency of use), and details about documentation (e.g., where/who documented).

RESULTS

Sixty-nine percent (121/176) of cancer patients had SU documented. Many patients (42%, 74/176) had only one substance documented; 66% (116/176) had alcohol use documented. For a substantial minority of patients (43/176; 24%), the provider did not specify the substance assessed (e.g., "drug use," "illicits"). SU was primarily documented by physicians (84%, 102/121), in routine progress notes (56%, 68/121), in the "social history" section of the note (84%, 102/121). Only 4 patients had a documented SU follow-up plan. When examining the subset of patients who reported problematic alcohol use (N = 27), the content of documentation was inconsistent (e.g., number of drinks/day vs. qualitative descriptors of use).

CONCLUSIONS

About 1/3 of oncology patients did not have SU assessment documented. SU other than alcohol use was infrequently documented, many clinicians documented SU but did not specify substance type, and few clinicians documented a follow-up plan for problematic SU. Oncology settings should utilize standardized assessment and referral for SU treatment.