Tobacco, nicotine, cannabis, and alcohol use among LGBTQ+ patients with cancer: Real-world analysis at an NCI-Designated Comprehensive Cancer Center

Background: Prior studies have described patterns of substance use, such as tobacco and alcohol use, that are elevated among sexual and gender minority (SGM) individuals with cancer. However, the findings have been limited to specific cancers and study designs (e.g., population-based survey). Real-world data can reveal important insights into the substance use behaviors among SGM cancer patients to meet the patients' needs and provide tailored cancer care. In this study, we conducted a real-world analysis on the association between substance use (tobacco, nicotine, cannabis, and alcohol) by SGM status. Methods: This study included 110,072 cancer patients who completed a standard-of-care electronic patient questionnaire (EPQ) during their initial visit at the Moffitt Cancer Center (Tampa, FL). The EPQ captures patient-reported information on demographics (including sexual orientation and gender identity [SOGI]), medical history, family cancer history, lifestyle factors, use of complementary and alternative medicine, and quality of life. SGM and non-SGM patients were identified using the SOGI items. The outcome variables included (1) past and current tobacco and nicotine product use, (2) recent alcohol use, and (3) recent substance and non-medically indicated prescription medication use. Pearson's Chi-Square test was utilized; significance was determined by p <0.05. Results: Approximately 3.1% of the population self-identified as an SGM. Compared to non-SGM patients, SGMs reported higher rates of current cigarette smoking (14.8% vs 10.7%; p <.001), smoking their first cigarette after waking up (within 5 minutes: 5.6% vs 4.7%; 6-30 minutes: 13.1 vs. 10.8%, p <.001), current pipe smoking (0.2% vs 0.1%, p <.001), current and former electronic cigarette use (4.0% vs 1.7% and 9.6% vs 4.3%, respectively, p <.001), alcohol use in the past year ( p <.001), more number of drinks on the days of alcohol use ( p <.001), and past 3-months cannabis use (4.7% vs 2.1%) along with sedatives and stimulants use ( p <.001). However, SGM reported lower use of ever pipe (2.0% and 2.8%, p <.001), ever and current cigar ( p <.01), ever and current smokeless tobacco ( p <.001), and alcohol more than 9 days per month ( p <.01). Discussion: These data suggest that SGM cancer patients, compared to non-SGM cancer patients, present with higher use of tobacco, nicotine, cannabis, and alcohol. These results add to the existing literature by elucidating patterns of substance use among SGM cancer patients with heterogeneous cancer types. Further research is warranted on the patterns of substance use among subgroups of SGM patients and the potential need for systematic assessment and early intervention.