US National Trends in Opioid-Related Hospitalizations Among Patients With Cancer

Abstract

Opioids are routinely prescribed for cancer-related pain, but little is known about the prevalence of opioid-related hospitalizations among patients with cancer. Opioid addiction among these patients has been estimated to be as high as 7.7%, 1 but our understanding of opioid misuse among patients with cancer is based on small, preliminary studies. 2 In light of the wider opioid epidemic, oncologists and palliative care clinicians frequently balance providing patients with legitimate access to opioids while protecting them and the general public from the risks associated with prescribing these medications. 3 Methods | We examined trends and risk factors of opioidrelated hospitalizations among patients with cancer between January 1, 2006, and December 31, 2014, using the US National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). 4 The database contained deidentified patient information and was deemed exempt from institutional review by the Partners Healthcare Human Research Committee. All analysis was conducted between December 2017 and September 2018. Our primary outcome was the number of opioid-related hospitalizations among adults with cancer (≥18 years old). We identified opioid-related hospitalizations using the International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for heroin poisoning, opioid poisoning, and opioid dependence or abuse in the primary diagnosis field. 5 We identified these patients using ICD-9 codes (140.0-239.9, 258.01-258.03, 789.51), while excluding conditions that rarely require opioids for pain control. We excluded the following: carcinomas in situ, benign neoplasms, hematologic cancers in remission, macroglobulinemia, polycythemia vera, essential thrombocythemia, and nonmelanoma skin cancers. A multivariable logistic regression model evaluated the association between opioid-related hospitalizations and age, sex, race/ethnicity, primary insurance type, median household income quartile, hospital type, geographic region, alcohol abuse, drug abuse, depression, psychotic disorder, comorbidities, and year of hospital discharge. Comorbidities were identified using the Elixhauser comorbidity software from HCUP 4 but excluded alcohol abuse, depression, drug abuse, metastatic cancer, lymphoma, psychotic disorder, and solid tumors without metastasis since these were analyzed independently. Weighted frequencies, proportions, and 95% confidence intervals (CIs) were calculated to reflect national estimates using inverse sampling weights provided by the NIS. 4 Trend weights were used for 2006 through 2011 to adjust for the sampling redesign that was implemented in 2012. 4

Acupuncture and acupressure with improved cancer-related depression of retrospective studies

“…The ongoing sedative drugs crisis in the America has exacerbated the challenges surrounding cancer treatment ( 40 – 43 ), with government organizations calling for the use of nonpharmacological interventions ( 44 – 46 ). Acupuncture and acupressure have been widely used in nonpharmacological interventions for cancer pain and various factors causing depression ( 12 , 47 – 50 ).…”

Incidence and Predictors of Persistent Opioid Use in Survivors of Head and Neck Cancer Treated With Curative Radiation

“…26 Opioid-related hospitalizations amongst cancer patients, which place patients at risk for infection and worsening financial burden, also have risen over the course of the past decade. 27 Finally, opioid analgesics may play a major role in delirium and cognitive impairment in cancer patients. 28,29 One major difficulty in prevention of long-term opioid use relates to the identification of aberrant versus appropriate usage of these medications.…”

Trends in opioid and non-opioid treatment for chronic non-cancer pain and cancer pain among privately insured adults in the United States, 2012–2019

“…Extant research on opioid prescribing patterns among CNCP patients has documented increases in opioid prescribing prior to 2010 using national samples and decreases in opioid prescribing after 2010 among non-national samples and populations with specific conditions, like arthritis [24][25][26][27]. Prior research has documented reduced opioid prescribing by oncologists among Medicare Part D beneficiaries [28] and a rise in opioid-related hospitalizations among patients with cancer [29]. No studies using national samples of adults have examined trends in receipt of opioid and non-opioid therapies among CNCP patients versus cancer patients in recent years.…”