Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors

Ji, Xu; Hu, Xin; Brock, Katharine E.; Mertens, Ann C.; Cummings, Janet R.; Effinger, Karen E.

doi:10.1093/jnci/djac049

Cited by 4 publications

(17 citation statements)

References 42 publications

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“…Cancer treatments (surgery, chemotherapy, radiation therapy) were identified using procedure codes and National Drug Codes. 6,7 Survivors were followed up from treatment completion through 1 year after treatment completion. 6,7 We matched enrollees without cancer to survivors based on birth year, sex, and geographic region.…”

Section: Data and Samplementioning

confidence: 99%

“…6,7 Survivors were followed up from treatment completion through 1 year after treatment completion. 6,7 We matched enrollees without cancer to survivors based on birth year, sex, and geographic region. 7 These enrollees were assigned the treatment completion date of matched survivors and assessed for continuous enrollment using this date.…”

Section: Data and Samplementioning

confidence: 99%

“…6,7 We matched enrollees without cancer to survivors based on birth year, sex, and geographic region. 7 These enrollees were assigned the treatment completion date of matched survivors and assessed for continuous enrollment using this date. 6,7 Five enrollees without cancer were randomly selected for each CCS (eMethods 1 in the Supplement).…”

Section: Data and Samplementioning

confidence: 99%

“…7 These enrollees were assigned the treatment completion date of matched survivors and assessed for continuous enrollment using this date. 6,7 Five enrollees without cancer were randomly selected for each CCS (eMethods 1 in the Supplement). 6,7 The Emory University Institutional Review Board approved this study under expedited review, waiving patient informed consent for deidentified or publicly available data, in accordance with 45 §CFR 46.110 and 21 CFR §56.110.…”

Section: Data and Samplementioning

confidence: 99%

“…6,7 Five enrollees without cancer were randomly selected for each CCS (eMethods 1 in the Supplement). 6,7 The Emory University Institutional Review Board approved this study under expedited review, waiving patient informed consent for deidentified or publicly available data, in accordance with 45 §CFR 46.110 and 21 CFR §56.110. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for observational studies.…”

Section: Data and Samplementioning

confidence: 99%

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Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline

Brock

Effinger

et al. 2022

JAMA Oncol

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ImportanceThe Centers for Disease Control and Prevention (CDC) released an opioid-prescribing guideline in March 2016. Little is known about the guideline’s potential effects on childhood cancer survivors, a population at high risk for pain.ObjectiveTo examine changes in opioid prescriptions and potential misuse/substance use disorders (SUD) among childhood cancer survivors and peers without cancer following the guideline release.Design, Setting, and ParticipantsIn this cohort study using the MarketScan Commercial Claims and Encounters Database, 8969 survivors who completed treatment for hematologic, central nervous system, bone, or gonadal cancers (aged ≤21 years at diagnosis) from 2009 to 2018 and 44 845 age-matched, sex-matched, and region-matched individuals without cancer were identified. With data aggregated based on the quarter-year of survivors’ treatment completion, interrupted time series analyses were conducted in this cohort study to estimate the immediate (level) change and change in time trend (trend change) for each outcome after the guideline release, accounting for autocorrelation. Data were analyzed from September 2021 to April 2022.ExposuresRelease of the CDC opioid-prescribing guideline.Main Outcomes and MeasuresOutcomes included any opioid prescription and any indicator for potential misuse/SUD within 1 year following completion of treatment.ResultsThis study included 8969 childhood cancer survivors (mean [SD] age, 13.7 [6.2] years old; 3814 [42.5%] female patients) and 44 845 peers without cancer (mean [SD] age, 13.7 [6.2] years old; 19 070 [42.5%] female patients). Before the guideline release, the opioid prescription rate (21.1% vs 7.2%) and rate of potential misuse/SUD (5.6% vs 1.9%) were higher among survivors than peers without cancer. After the guideline release, the trend in opioid prescription rate declined among survivors (trend change, −1.1 percentage points [ppt]; P &lt; .001; 95% CI, −1.5 to −0.7). Survivors also experienced an immediate level decrease (−2.1 ppt; P = .04; 95% CI, −4.2 to −0.1) and a decreasing trend (trend change, −0.4 ppt; P = .009; 95% CI, −0.6 to −0.1) in rate of potential misuse/SUD. Peers without cancer experienced decreasing trends in opioid prescription rate (trend change, −0.3 ppt; P &lt; .001; 95% CI, −0.5 to −0.1) and rate of potential misuse/SUD (trend change, −0.1 ppt; P = .03; 95% CI, −0.1 to −0.01). By 2 years after the guideline release, relative reductions in opioid prescription rate and rate of potential misuse/SUD among survivors were 36.7% and 65.4%, respectively, with peers without cancer experiencing smaller reductions (15.9% and 29.9%).Conclusions and RelevanceIn this cohort study, the opioid prescription rate and rate of potential misuse/SUD declined among both survivors and peers without cancer following the CDC guideline release, with survivors experiencing greater reductions. More research is needed to understand the guideline’s potential effects on access to opioids required for pain control among childhood cancer survivors.

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Section: Data and Samplementioning

confidence: 99%

Section: Data and Samplementioning

confidence: 99%

Section: Data and Samplementioning

confidence: 99%

Section: Data and Samplementioning

confidence: 99%

Section: Data and Samplementioning

confidence: 99%

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Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline

Brock

Effinger

et al. 2022

JAMA Oncol

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Mental Health Care Utilization Among Parents of Children With Cancer

Hu,

Grosse,

Han

et al. 2024

JAMA Netw Open

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ImportanceCaring for children diagnosed with cancer may adversely affect the mental health (MH) of parents.ObjectiveTo characterize utilization of MH services among parents of children with vs without cancer using nationwide commercial claims data.Design, Setting, and ParticipantsFor this cross-sectional study, the Merative MarketScan Commercial Claims Database was used to identify continuously insured families of children treated for cancer (aged ≤21 years at diagnosis) during 2010 to 2018, compared with families who matched eligibility criteria but did not have a child with a cancer history. Parents were assessed from 18 months before to 12 months after their child’s cancer diagnosis. Analyses were conducted from February 2022 to September 2023.ExposuresChildren’s cancer diagnosis.Main Outcomes and MeasuresOutcomes included parents’ MH-related visits during the first year following their child’s cancer diagnosis. Logistic regressions compared outcomes between families of children with vs without cancer, adjusting for sociodemographic and clinical factors.ResultsThis study included 4837 families of children with cancer (4210 mothers and 4016 fathers) and 24 185 families of children without cancer (21 444 mothers and 19 591 fathers) with continuous insurance enrollment. Most household leads were aged 35 to 54 years (3700 [76.5%] in families of children with cancer vs 17 812 [73.6%] in families of children without cancer) and resided in urban areas (4252 [87.9%] vs 21 156 [87.5%]). The probabilities of parents having anxiety-related visits (10.6% vs 7.0%), depression-related visits (8.4% vs 6.1%), and any MH-related visits (18.1% vs 13.3%) were higher in families of children with vs without cancer. Adjusted analyses showed absolute increases of 3.2 percentage points (95% CI, 2.3 to 4.0; 45.7% relative increase), 2.2 percentage points (95% CI, 1.4 to 3.0; 36.1% relative increase), and 4.2 percentage points (95% CI, 3.1 to 5.3; 31.3% relative increase) in the probabilities of 1 or both parents having anxiety-related visits, depression-related visits, and any MH-related visits, respectively, among families of children with vs without cancer. Such differences were greater in magnitude among mothers than fathers.Conclusions and RelevanceIn this cohort study of privately insured parents, those caring for children with cancer had a higher likelihood of utilizing MH care than other parents. These findings underline the importance of interventions toward targeted counseling and support to better meet MH care needs among parents and caregivers of children with cancer.

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Utilization of cardiac tests in anthracycline‐treated cancer survivors differs between young adults and children: A claims‐based analysis

Ji,

Hu,

Lipscomb

et al. 2023

Cancer Medicine

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BackgroundThe Children's Oncology Group Guidelines recommend a cardiacechocardiogram, or comparable functional imaging, following therapy completion in survivors of childhood/adolescent cancers exposed to anthracyclines.MethodsUsing the 2009–2019 Merative™ MarketScan® Commercial Database, we examined real‐world utilization of cardiac testing among 1609 anthracycline‐treated survivors of childhood/adolescent cancers.ResultsThe cumulative incidence of receiving an initial cardiac test by 5.25 years from the index date (six months after end‐of‐therapy) was 62.3% (95% CI = 57.5%–66.7%), with median time to initial test being 2.7 years (95% CI = 2.5%–3.1%). Young adults (18–28 years) were less likely than children (≤17 years) to receive cardiac testing (hazard ratio [HR] = 0.42, 95% CI = 0.3%–0.49%). More likely to receive cardiac testing were survivors receiving hematopoietic stem cell transplantation versus chemotherapy only (HR = 2.23, 95% CI = 1.63%–3.03%), and survivors with bone or soft tissue versus hematologic cancer (HR = 1.64, 95% CI = 1.30%–2.07%).ConclusionsNearly 40% of anthracycline‐treated survivors of childhood/adolescent cancers had not received cardiac testing within 5.25 years post‐index date, with young adults least likely to receive a test.

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Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors

Cited by 4 publications

References 42 publications

Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline

Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline

Mental Health Care Utilization Among Parents of Children With Cancer

Utilization of cardiac tests in anthracycline‐treated cancer survivors differs between young adults and children: A claims‐based analysis

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