Exploring oncology clinician and staff experiences with substance use disorders among cancer patients.
Authors: Mina Bakhtiar, Phoebe M Rust, Joanna M. Streck, Rachel Rosen, Miranda Lam, Elyse Richelle Park, Helen Alice Shih
Journal: Journal of Clinical Oncology (2025)

e13821 Background: There is a rising rate of substance use disorders (SUD) among cancer patients in the United States. We explored the experiences, perceptions, and management of this population by oncology clinicians and staff at an NCI-designated cancer center. Methods: An anonymous survey was administered to oncology clinicians and staff at the Massachusetts General Hospital Cancer Center. Respondents provided details on their demographic and educational background, experiences with SUD, and suggestions to improve treatment for this population. Descriptive statistics were calculated. Chi-square tests were conducted to test associations between professional classifiers and experiences caring for patients with SUD. Results: Between September-December 2024, 228 individuals responded to the survey. Respondents were most commonly between ages 41-60 (65, 28.5%); 76.7% identified as female. Medical Oncology (39%), Radiation Oncology (24.6%), Surgical Oncology (2.2%), and other divisions such as palliative care were represented. Respondents had varying educational degrees (Medical Doctorate/Doctor of Osteopathic Medicine (MD/DO): 26.8%; Registered Nurse (RN): 21.9%; Nurse Practitioner/Physician Assistant (NP/PA): 12.7%; Bachelor’s: 15.4%, among others). Respondents had been practicing for a mean of 15.7 years (Std Dev: 11.2). One-hundred and ninety-six respondents (85.9%) had seen patients with substance use or SUD in the prior year. Those with a degree of MD/DO or RN were significantly more likely to report encounters with SUD than any other degree (MD/DO: χ2= 3.86, p = 0.05; RN: χ2= 5.35, p = 0.02). Individuals who reported no disease site specialty were also significantly more likely to report encounters with SUD than any single disease site specialty (χ2= 13.62, p &lt; 0.001). Fifty-three percent of respondents (121) endorsed challenges providing care due to SUD. Perceived reasons for disruption of care included mental health diagnoses (37.3%), unstable housing (27.2%), and limited health literacy (25.9%). Seventy-seven percent (175) felt that oncology clinicians should screen for SUD, but only 35% (80) felt confident in their ability to do so. The majority (140 respondents, 61%) “rarely” or “never” referred for SUD assessment or treatment. When asked about barriers to screening and referral, some cited a lack of time (79 respondents, 34.7%). Proposed solutions included formal training or education in SUD and an SUD screening tool in intake forms or the electronic medical record. Conclusions: A survey of clinicians and staff at our cancer center suggests that they encounter patients with SUD and believe it is important to screen for SUD. However, respondents reported that they rarely screen for SUD or refer for treatment, citing barriers such as a lack of confidence and insufficient time. Future work should develop training tools that support oncology clinicians in caring for this population.