Cancer survivorship and opioid prescribing rates: A population‐based matched cohort study among individuals with and without a history of cancer

Sutradhar, Rinku; Lokku, Armend; Barbera, Lisa

doi:10.1002/cncr.30839

Cited by 82 publications

(78 citation statements)

References 27 publications

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“…The American Cancer Society also reported substantially higher opioid prescribing rates among cancer survivors (1.22 times higher) than among their counterparts who have never had cancer. Interestingly, opioid use was prevalent even among survivors who were 10 or more years past their cancer diagnosis . In a recent study describing opioid prescription patterns among patients with cancer, an HNSCC diagnosis was associated with increased odds of opioid prescription and a larger prescription quantity than patients with lung or colon cancer .…”

Section: Discussionmentioning

confidence: 99%

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Silver

Dourado

Hitchcock³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use. Study Design Retrospective cohort study. Methods A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival. Results The average age was 62 years, and the mean follow‐up was 38 months. Eighty‐three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty‐nine percent were HPV/p16 positive. Fifty‐seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration. Conclusions More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long‐term pain management in this patient population. Level of Evidence 4 Laryngoscope, 129:2087–2093, 2019

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Section: Discussionmentioning

confidence: 99%

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Silver

Dourado

Hitchcock³

et al. 2019

The Laryngoscope

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“…Chronic opioid use has become a significant public health issue in our country. Cancer survivors are a vulnerable population with significantly higher rates of reported opioid use, even a decade after attaining survivorship . Patients with head and neck cancer often suffer significant morbidity as a result of their underlying disease process as well as treatment sequelae.…”

Section: Discussionmentioning

confidence: 99%

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Bollig

Jorgensen

2019

Head & Neck

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Background The effect of treatment modality on long‐term opioid dependence in patients with oropharyngeal cancer has not been reported. Methods A retrospective cohort of 122 patients with T1/T2 oropharyngeal cancer undergoing treatment was generated. Risk factors associated with chronic opioid use were investigated by univariate and multivariate analyses. Results The prevalence of chronic opioid use was 45.9%. On multivariate analysis, primary nonsurgical treatment (odds ratio [OR] 4.5, 95% confidence interval [CI]: 1.7‐11.4), pretreatment opioid use (OR 14.9, 95% CI: 3.5‐62.5), psychiatric disorder (OR 4.3, 95% CI: 1.03‐18.5), alcohol use (OR 2.6, 95% CI: 1.03‐6.5), and younger age (OR 1.1, 95% CI: 1.02‐1.11) were significantly associated with chronic opioid use. Conclusion Primary nonsurgical treatment, younger age, pretreatment opioid use, alcohol use, and psychiatric disorder were independently associated with an increased risk of chronic opioid use. Preventative strategies should be especially focused toward these patients to reduce their risk of long‐term opioid use.

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“…As cancer survivors live longer, pain from other conditions becomes common . A study out of Canada found opioid prescribing to be 1.2 times higher among cancer survivors than matched controls . This coupled with evidence that opioids influence multiple well‐established cancer pathways such as immune suppression, cell proliferation, cell invasion, and angiogenesis, points to a need for clinical studies of the effects of chronic use on cancer outcomes in diverse population and across different cancers.…”

Section: Discussionmentioning

confidence: 99%

Risk of second breast cancer events with chronic opioid use in breast cancer survivors

Boudreau

Chen

et al. 2019

Pharmacoepidemiology and Drug

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Purpose Opioids may increase cancer risk and progression through multiple pathways. Our objective was to estimate the association between chronic opioid use and risk of second breast cancer events (SBCEs). Methods Cohort study of women greater than or equal to 18 years, diagnosed with early stage breast cancer between January 1, 1990, and December 31, 2008, and enrolled in a large health plan for 1+ years before and after (unless died) diagnosis. SBCEs were defined as evidence of recurrence or second primary breast cancer in the medical chart. Chronic opioid use was defined as 75+ days of use in any moving 90‐day window after breast cancer diagnosis and varied to 150+ days in a 180‐day window in a sensitivity analysis. Using Cox proportional hazards models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for SBCE and components of SBCE by chronic opioid use. Results Almost 10% met the criteria for chronic use and almost a third of users were taking opioids for greater than 3 years. Risk of SBCEs (HR = 1.20; 95% CI, 0.85‐1.70), including second primary breast cancer (HR = 1.38; 95% CI, 0.71‐2.70), was nonsignificantly higher among chronic users vs nonchronic/nonusers. The HR for recurrence was 1.14 (95% CI, 0.76‐2.70). Results of the sensitivity analyses on longer opioid use does support an association with SBCE or recurrence. Conclusion This first US‐based study on chronic opioid use and cancer outcomes provides some reassurance on safety. However, the question warrants further exploration in other populations and settings.

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Cancer survivorship and opioid prescribing rates: A population‐based matched cohort study among individuals with and without a history of cancer

Cited by 82 publications

References 27 publications

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Risk of second breast cancer events with chronic opioid use in breast cancer survivors

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