Background
Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUD) among pediatric cancer survivors during the first year post-therapy.
Methods
Using MarketScan® Commercial Database, we identified 8,969 survivors (aged ≤21 years at diagnosis) who completed cancer therapy in 2009–2018 and remained continuously enrolled for ≥1 year post-therapy, and 44,845 age-, sex-, and region-matched enrollees without cancer as controls. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUD within 1-year post-therapy. Outcomes were compared between survivors and controls in bivariate and adjusted analyses, stratified by off-therapy age (children: 0–11 years; adolescents: 12–17 years; young adults: 18–28 years). All statistical tests were 2-sided.
Results
A higher proportion of survivors than controls filled opioid prescriptions (children: 12.7% versus 2.0%; adolescents: 22.9% versus 7.7%; young adults: 26.0% versus 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%–404.8% more likely than controls to fill opioid prescriptions (p-values < 0.001). The prevalence of potential misuse or SUD was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling ≥1 criterion; however, it was higher than controls (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained ≥2 times higher than that among controls (p-values < 0.001), while the difference in SUD became non-statistically significant.
Conclusion
Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1-year post-therapy, as compared to peers without cancer.