Cross-sectional analysis of neurocognitive impairment and substance use in adult survivors of childhood cancer

Adult survivors of childhood cancer are at risk for neurocognitive impairment, emotional distress, and chronic pain, factors independently associated with substance use. Cross-secional analysis from the Childhood Cancer Survivor Study examined domain-specific neurocognitive impairments and their interactions with psychological distress and pain in relation to substance use. The analysis included 11,151 participants (mean age 31.4 ± 7.5 years; 53.2% female). Survivors reported risky (40.9%) or heavy (11%) alcohol use and previous (14.6%) or current (13.7%) cigarette use. Impaired emotional regulation was associated with smoking (OR 1.81; 95% CI 1.53-2.14) and risk drinking (1.59; 1.25-2.03). Impaired emotional regulation with somatization was associated with decreased occasional drinking (0.54; 0.0-0.95) and heavy drinking (0.54; 0.0-0.95). Organization impairment with somatization was associated was associated with decreased heavy drinking (0.34; 0.15-0.73), whereas pain with organization impairment was associated with increased occasional drinking (1.81; 1.03-3.19) and risky drinking (2.18; 1.24-3.85). Memory impairment was associated with risky drinking (1.38; 1.10-1.73) and occasional drinking (1.37; 1.09-1.71). The authors conclude that neurocognitive impairment was associated with substance use and was modified by psychosomatic symptoms.