Substance use and survival after treatment for chronic myelogenous leukemia (CML) or myelodysplastic syndrome (MDS).
BACKGROUND
Patients' substance use problems are a particularly understudied aspect of psychosocial variables in cancer treatment.


OBJECTIVE
The specific hypothesis tested was that lifetime substance use disorders increased the risk of adverse outcome, in the context of other psychosocial and clinical characteristics demonstrated in other studies to have an impact on treatment outcome.


METHODS
Prospective cohort study of 106 adults with chronic myelogenous leukemia or primary myelodysplastic syndrome. None satisfied criteria for current substance abuse or dependence, but the lifetime rates of substance use disorders in this sample were 28% for alcohol, 12% for cannabis, and 9% for cocaine.


RESULTS
Participants received treatment as directed by their physicians, and were followed until death or the end of the study (median 1.5 years). Twenty-eight died. Multivariate survival analysis identified three predictors of outcome: lifetime cocaine use, associated with a six-fold increased risk of death (p = .04), and two protective variables, baseline hemoglobin (p = .002) and estimated intelligence quotient (IQ) (p = .04).


CONCLUSIONS
The results of this study highlight the potential significance of substance use disorders, and lifetime cocaine diagnoses in particular, on treatment outcome for people with chronic myelogenous leukemia or myelodysplastic syndrome. Whereas neither lifetime alcohol nor cannabis use were associated with survival on either the univariate or multivariate models of survival, lifetime cocaine diagnoses were associated with significant six-fold increased risk of death (p = .04).
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA. gchang@partners.org
Grace
G
Chang
Mary-Ellen
ME
Meadows
Jennifer A
JA
Jones
Joseph H
JH
Antin
E John
EJ
Orav
D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007360:Intelligence; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000378:metabolism / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000378:metabolism / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome
D006454:Hemoglobins