Care for patients with cancer and substance use disorders: a qualitative study of oncology team experiences.
Sachin S Kale, Laura J Rush, Jennifer L Eramo, Mireille Bitangacha, Sadie Chen, Devon K Check, Katie Fitzgerald Jones, Jessica Merlin, Ann Scheck McAlearney
Author Information
Sachin S Kale: Division of Palliative Medicine, Department of Internal medicine, College of Medicine, The Ohio State University Wexner Medical Center, 1581 Dodd Drive, Columbus, OH, 43210, USA. Sachin.Kale@osumc.edu.
Laura J Rush: The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4100, Columbus, OH, 43202, USA.
Jennifer L Eramo: The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4100, Columbus, OH, 43202, USA.
Mireille Bitangacha: The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4100, Columbus, OH, 43202, USA.
Sadie Chen: The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4100, Columbus, OH, 43202, USA.
Devon K Check: Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Katie Fitzgerald Jones: New England Geriatrics Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, MA, USA.
Jessica Merlin: Division of General Internal Medicine, CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ann Scheck McAlearney: The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4100, Columbus, OH, 43202, USA.
PURPOSE: Clinical decisions surrounding cancer care can be complicated by co-occurring substance use disorders (SUDs), particularly with respect to pain management and cancer treatment safety. Yet, few studies have examined oncology teams' experiences treating patients with co-occurring cancer and SUDs. We therefore sought to understand the perspectives of oncology team providers regarding the challenges they face when caring for patients with cancer and SUDs. METHODS: We conducted a qualitative study to understand the experiences of clinicians who have provided cancer care to patients with concurrent SUD. Questions about substances used focused mainly on non-prescribed opioids and stimulants. Individual interviews were conducted in March-July 2023 by telephone or videoconference, recorded, transcribed verbatim, and analyzed rigorously using thematic analysis. RESULTS: Twenty-seven individuals were interviewed (15 physicians, 8 advanced practice providers, 2 registered nurses, and 2 social workers). Specialties included medical oncology, hematology, radiation oncology, and gynecology oncology. We identified four themes representing the challenges oncology teams face when caring for patients with cancer and SUD: (1) patients' unmet social needs; (2) uncertainty about pain management options; (3) implicit biases about patients with SUDs; and( 4) patients' active substance use. CONCLUSION: Oncology teams face many challenges when caring for patients with cancer and SUDs. Understanding these challenges is critical and can both inform the design of interventions for patients with cancer and SUD and guide future research.
