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

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Abstract

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.

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Funding

This work was supported by the National Cancer Institute [R01 CA166147-05, K24CA197382]. Support for JMS was provided by the National Institute on Drug Abuse [NIDA K12 DA043490]. The content is solely the responsibility of the authors and does not necessarily represent the official views of NCI or NIDA.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA

    Joanna M. Streck, Hyo Jin Shin & Elyse R. Park

  2. Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA

    Joanna M. Streck, Susan Regan & Elyse R. Park

  3. Harvard Medical School, Boston, MA, USA

    Joanna M. Streck, Susan Regan & Elyse R. Park

  4. Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA

    Joanna M. Streck, Angela W. Walter, Colin J. Ponzani & Elyse R. Park

  5. Department of Public Health, University of Massachusetts, Lowell, MA, USA

    Angela W. Walter

  6. MGH Cancer Center, Boston, MA, USA

    Jennifer S. Temel & Areej El- Jawahri

  7. MGH Center for Biostatistics, Boston, MA, USA

    Alona Muzikansky

  8. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jamie S. Ostroff

Authors
  1. Joanna M. Streck
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  2. Angela W. Walter
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  3. Jennifer S. Temel
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  4. Areej El- Jawahri
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  5. Hyo Jin Shin
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  6. Susan Regan
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  7. Alona Muzikansky
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  8. Colin J. Ponzani
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  9. Jamie S. Ostroff
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  10. Elyse R. Park
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Contributions

Conceptualization: ERP, JMS, JST, and JSO.

Data curation: JMS, AM, and HJS.

Formal analysis: AM, JMS, and HJS.

Funding acquisition: ERP.

Investigation: ERP, CJP, JSO, JST, and SR.

Methodology: ERP, JMS, JSO, JST, and SR.

Drafting preliminary drafts of manuscript: JMS, ERP, and AWW.

All the authors read and approved of the final manuscript.

Corresponding author

Correspondence to Joanna M. Streck.

Ethics declarations

Ethics approval

All participants enrolled in the parent study provided written informed consent, and the parent study received IRB approval.

Consent to participate

All authors have read, reviewed, and approved of this manuscript for publication and agreed to participate as authors on the manuscript.

Consent for publication

All authors have read, reviewed, and approved of this manuscript for publication in its present form.

Competing interests

Drs. Ostroff and Park receive royalties from UpToDate. No other authors have conflicts of interest to disclose.

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Streck, J.M., Walter, A.W., Temel, J.S. et al. Investigating documentation of alcohol and non-medical substance use in oncology treatment: an electronic health record review. Support Care Cancer 30, 4275–4281 (2022). https://doi.org/10.1007/s00520-021-06688-7

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  • DOI: https://doi.org/10.1007/s00520-021-06688-7

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