Intro to AYA Patients, Survivors, and Substance Use

Preventative intervention is necessary to reduce risk of substance abuse for young adults and adolescents who have survived cancer.

Adolescence, marked by rapid physical, cognitive, and psychosocial growth, is a time of exploration and independence for many. For adolescent and young adult (AYA) patients with cancer ages 15-25, these markers of development are often impeded by their diagnosis and treatment, leaving AYA survivors to experience conflicting feelings of maturity and developmental delay.¹ This delay can lead AYAs to begin risk-taking experimentation later than their peers.

Risk-taking partnered with the physical and psychological late effects of cancer and reduced health-promoting behaviors can impact AYAs’ judgment toward making health-promoting decisions, which can make risky behaviors, such as substance use, increasingly impactful.²

AYA cancer survivors, due in part to heightened risk-taking behaviors of this developmental stage, have a greater possibility of developing substance use disorders (SUD), possibly because of factors including pain management and access to and misuse of prescription drugs,³ making them more vulnerable to long-term health issues.⁴

Limitations to education, social support, and insurance funding for follow-ups post treatment are risk factors for AYAs in receiving interventions that encourage health-promoting behaviors, leaving AYAs increasingly exposed and necessitating prevention and intervention-focused support.¹

Impact

Studies show that the use of alcohol, tobacco, and illicit drugs and misuse of prescription opioids is higher for AYA cancer survivors than their non-cancer peers.³ Substance use is a leading cause of death in AYA cancer survivors as it can worsen and compound existing cancer-related vulnerabilities and morbidities. In addition to the health concerns of potential addiction, chronic use of opioids in cancer survivors can aggravate tumor progression, negatively impact fertility, and cause neurotoxicity.³

For AYA patients with cancer and survivors, risk factors of substance use, including low commitment to school and increased stressors, are constantly present. These factors compound preexisting age and development-related concerns of body image, sexual development, impaired judgment toward consequences, and peer relationship disruption. This can lead to social isolation and loneliness, which, in conjunction with worry and perception of susceptibility to late effects of cancer, are among the strongest predictors and risk factors for substance abuse in AYA survivors.¹

Limitations of Support

To effectively support the AYA population through prevention and interventions for SUD, it is imperative to have a greater understanding of the use, misuse, and addiction that occurs in this population compared to non-cancer peers.³ However, these studies are often done on small sample sizes that don’t account for racial or cultural differences, highlighting a lack of representation for this population and limiting the knowledge and informed support required for necessary interventions.³

Following treatment completion, AYAs are faced with a lack of support from their adult healthcare and insurance, as studies emphasize.¹ AYA cancer survivors have the highest rate of uninsured individuals in the country, complicating the accessibility of support or medical independence¹and creating a barrier to health-promoting interventions or effective screenings.

In addition to practical and financial barriers to support, studies show that AYA patients with cancer and survivors often do not endorse a need for support surrounding intimate topics like sexual and substance use behaviors, despite engaging in these behaviors throughout and following treatment.⁵ Often, the aforementioned developmental stage that normalizes risk-taking behaviors presents itself through attitudes toward substance use, with patients acknowledging it as a coping mechanism or typical behavior, saying in one study, “I can't wait to get back to normal [drinking with my friends],” or “[I get through this with] a lot of drugs.”⁵

How to Encourage Health-Promoting Behaviors

Interventions that encourage health-promoting behaviors for substance use prevention and cessation are more effective when implemented in tandem with mental health survivorship care.⁶

Education: AYA cancer survivors would benefit from increased knowledge surrounding health risks and risk factors related to substance use and abuse. AYA survivors’ emphasis on fears surrounding recurrence and poor health outcomes is a focal point for promoting education.¹

Psychosocial Support: Increased attention to mental health-related concerns and the promotion of coping skills, exercise, nutrition, and psychoeducation was effective in creating an increased desire for change and reduction of health-risk behaviors.¹

Resources: As post-treatment support often dwindles, advocacy for extended support and referrals to additional resources including support groups, follow-up care providers, and general practitioners can help create balance for survivors.⁶

Oncology nurses play an integral role in supporting AYAs through their cancer journeys. Recognizing limitations to support and supplementing with increased levels of awareness, education, and referrals are ways in which oncology nurses can best prepare this population to incorporate health-promoting behaviors.

References

1. Jones BL. Promoting healthy development among survivors of adolescent cancer. Fam Community Health. 2008;31 Suppl 1:S61-S70. doi:10.1097/01.FCH.0000304019.98007.ae
2. Hudson MM, Findlay S. Health-risk behaviors and health promotion in adolescent and young adult cancer survivors. Cancer. 2006;107(7 Suppl):1695-1701. doi:10.1002/cncr.22103
3. Ji X, Cummings JR, Mertens AC, Wen H, Effinger KE. Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors-Results from a national survey. Cancer. 2021;127(17):3223-3231. doi:10.1002/cncr.33634
4. Reuben SH, National Cancer Institute. Living beyond cancer: finding a new balance: President's Cancer Panel 2003-2004 annual report. NIH. May 2004.
5. Rosenberg AR, Bona K, Ketterl T, Wharton CM, Wolfe J, Baker KS. Intimacy, substance use, and communication needs during cancer therapy: a report from the "Resilience in adolescents and young adults" study. J Adolesc Health. 2017;60(1):93-99. doi:10.1016/j.jadohealth.2016.08.017
6. Milam J, Slaughter R, Meeske K, et al. Substance use among adolescent and young adult cancer survivors. Psychooncology. 2016;25(11):1357-1362. doi:10.1002/pon.3958