PURPOSE: Clinical decisions surrounding cancer care can be complicated by co-occurring substance use disorders (SUDs), particularly with respect to pain management and cancer treatment safety. Yet, few studies have examined oncology teams' experiences treating patients with co-occurring cancer and SUDs. We therefore sought to understand the perspectives of oncology team providers regarding the challenges they face when caring for patients with cancer and SUDs. METHODS: We conducted a qualitative study to understand the experiences of clinicians who have provided cancer care to patients with concurrent SUD. Questions about substances used focused mainly on non-prescribed opioids and stimulants. Individual interviews were conducted in March-July 2023 by telephone or videoconference, recorded, transcribed verbatim, and analyzed rigorously using thematic analysis. RESULTS: Twenty-seven individuals were interviewed (15 physicians, 8 advanced practice providers, 2 registered nurses, and 2 social workers). Specialties included medical oncology, hematology, radiation oncology, and gynecology oncology. We identified four themes representing the challenges oncology teams face when caring for patients with cancer and SUD: (1) patients' unmet social needs
(2) uncertainty about pain management options
(3) implicit biases about patients with SUDs
and( 4) patients' active substance use. CONCLUSION: Oncology teams face many challenges when caring for patients with cancer and SUDs. Understanding these challenges is critical and can both inform the design of interventions for patients with cancer and SUD and guide future research.