Documentation of Substance Use in Adolescent and Young Adult Cancer Patients

Title: Documentation of Substance Use in Adolescent and Young Adult Cancer Patients Anika Galagoda, OMS-II, Holly Lout, OMS-II, Corey Heath, PhD, Karen Albritton, MD, Alice Hoeft, MS, Tyler Hamby, PhD Background: Cancer remains the leading cause of disease-related death in the Adolescent and Young Adult (AYA) population, ages 15-39. One psychosocial circumstance influencing the management of this population is substance use. Substance use can impair judgement which may affect patient adherence to treatment protocol. Substance use may lead to poorer health outcomes and can increase the risk for secondary malignancies. It is important for clinicians to ask about substance use in AYA patients so they can prevent these adverse effects. Purpose: The purpose of this study was to examine the quality of the documentation of substance use behaviors among this population at Cook Children’s Medical Center (CCMC) before and after the implementation of an AYA program at CCMC in 2011. Methods: This study used a retrospective analysis of patient charts aged 15-35 years old at the time of diagnosis who were treated at CCMC between 2008 and 2014. Patients with brain and thyroid tumors were excluded. Quality of documentation was compared before and after the AYA program was started. The variables collected include documentation of tobacco, alcohol, and illicit drug use before and during treatment. Chi-square analyses and odds ratios (OR) were used to compare rates of documentation. Results: There were 169 patients who met inclusion criteria. Clinician documentation of history of substance use was highest with tobacco use (72%) followed by alcohol use (32%) and drug use (30%). Additionally, documentation was significantly better after the implementation of the AYA program for tobacco use before (pppppp=.10; OR=1.75), treatment. Conclusions: Providers were more likely to document tobacco use than alcohol or drug use. Documentation improved after a programmatic focus on AYA care was established. Despite this, most charts reviewed did not document alcohol or drug use, so thorough and consistent documentation is still needed in order to see if there is a relationship between these variables and the outcomes of AYA patients.