Factors Associated With Opioid Use in Long-term Cancer Survivors

Abstract

Purpose. To evaluate factors associated with opioid use in patients with cancer surviving more than five years without recurrence. We evaluated exposures of opioid use before cancer diagnosis, opioid use between cancer diagnosis and five-year anniversary, surgeries, and chemotherapy.Methods. We conducted a retrospective cohort study using linked provincial administrative data. Patients were aged 24e70 years and eligible for government-funded pharmacare. The index date was the five-year anniversary from diagnosis. Patients were accrued between 2010 and 2015. The main outcome was opioid prescription rate after index date. The main exposures were opioid use before diagnosis, opioid use between diagnosis and index, surgeries, and chemotherapy. A negative binomial regression model was used to estimate relative rates (RR) of opioid use after index date.Results. Our cohort included 7431 individuals. The overall crude prescription rate after the index date was 2 per personyear. The factor most strongly associated with a higher rate of opioid use after index was continuous opioid use between diagnosis and index (RR 46.1, 95% confidence interval 34.8e61.2). Opioid use before diagnosis was also a factor (RR ¼ 1.8, 95% confidence interval 1.44e2.19). A history of depression, comorbidity, and more than two years of diabetes were also associated with higher risk of posteindex date opioid use. Significant interactions were identified between prior opioid use and opioid use between diagnosis and index. Most prescriptions are from family physicians. Conclusion.Patients who use opioids continuously between diagnosis and index date are at increased risk of continued use after five years of survival. Safe and appropriate pain management is an important survivorship issue.

Variations in Long‐term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000‐2019)

“…Some studies investigated opioid use among patients with various specific health conditions: 43 studies 24,26–28,31,37,43,48,49,51,52,59,62,65,70,74,77–80,82–104 focused on noncancer pain, 14 studies 55,56,64,69,105–114 on musculoskeletal conditions, 13 studies 38–40,57,81,115–122 on injuries or trauma and eight studies 23,32,53,67,75,123–125 on infectious diseases. Seven studies 41,44,45,71,126–128 included patients with both cancer and noncancer pain, and six studies evaluated patients with cancer 60,129,130 or cancer survivors 61,131,132 . (Table 1)…”

Approaches to opioid prescribing in cancer survivors: Lessons learned from the general literature

“…16 It may be challenging to recognize a problematic pattern of opioid use in cancer survivors who experience fragmented care and fluctuating symptoms, which can result in many opioid prescribers and dose adjustments. 66 In addition, there are common opioid challenges that do not meet the criteria for OUD but may increase opioid risks. One opioid challenge may include what some have termed complex persistent opioid dependence, a condition seen in people on LTOT characterized by poor pain control and declining function.…”

“…OUD‐related behaviors may manifest differently in individuals receiving opioids from medical sources versus those receiving them from nonmedical (ie, illicit) ones 16 . It may be challenging to recognize a problematic pattern of opioid use in cancer survivors who experience fragmented care and fluctuating symptoms, which can result in many opioid prescribers and dose adjustments 66 …”

Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice

“…Safe and appropriate pain management, including prevention of opioid misuse or abuse, is an important survivorship issue (30). Indeed, cancer is associated with current opioid use (31).…”