In the Journals

Chronic opioid use more common among certain older cancer survivors

Three large populations of older cancer survivors demonstrated varying degrees of chronic opioid use, with colorectal and lung cancer survivors showing higher rates of chronic use 1 year after diagnosis than matched controls without cancer, according to a study published in Journal of Clinical Oncology.

However, by 6 years, survivors appeared no more likely to be chronic users than controls, results showed.

“Cancer survivors may have greater pain management needs, experience greater health risks and have less coordinated care than patients without cancer,” Talya Salz, PhD, assistant attending outcomes research scientist at Memorial Sloan Kettering Cancer Center, and colleagues wrote. “Our study focused on chronic opioid use, which has unclear benefits and is associated with long-term harms, including dependence, overdose and fractures. We investigated whether older cancer survivors of three common cancers were at increased risk for chronic opioid use and high-dose opioid use in the years after cancer treatment, accounting for trends in the general population.”

Salz and colleagues used SEER and Medicare data to conduct multilevel logistic regression analyses of chronic opioid use (90 consecutive days or longer) among survivors of colorectal (n = 13,101), lung (n = 11,859) and breast cancers (n = 21,829). The analysis included patients aged 66 years and older who were diagnosed between 2008 and 2013 and had not received opioids prior to diagnosis.

Researchers matched survivors at diagnosis date (index date) to three noncancer controls based on sex, race, Charlson comorbidity score and birth year. They then compared rates of high-dose opioid use (average 90 morphine mg equivalents or more daily) among cases and controls with chronic use.

Results showed opioid use among matched controls increased as the controls aged, particularly among those matched to patients with breast cancer (2.9% in the first year after index date to 7.3% in the sixth year after index date).

Colorectal cancer survivors demonstrated rates of chronic opioid use ranging from 2% in the first year after diagnosis to 4.3% at 6 years after diagnosis. These survivors appeared more likely than controls to demonstrate chronic opioid use in the first year (OR = 1.34; 95% CI, 1.22-1.47) and second year (OR = 1.17; 95% CI, 1.07-1.29) after diagnosis. The difference did not retain statistical significance by 3 years.

In the first 3 years after diagnosis, colorectal cancer survivors were more likely to have high-dose opioid use than controls, with ORs ranging from 1.79 to 2.61 (all P < .05).

Lung cancer survivors demonstrated the highest unadjusted rates of chronic opioid use vs. other survivor groups in the years after diagnosis and within each calendar year. These survivors also appeared more likely than controls to demonstrate chronic opioid use for the first 5 years after the index date, however, to a diminishing extent from year 1 (OR = 2.55, 95% CI, 2.34-2.77) to year 5 (OR = 1.34; 95% CI, 1.08 to 1.66).

Lung cancer survivors had greater odds of high-dose opioid use during the first 4 years after index date than controls, with ORs of 3.65 to 5.54 (P < .05).

Rates of chronic opioid use among breast cancer survivors ranged from 1.9% in the first year after diagnosis to 3.7% in the sixth year. These survivors demonstrated a lower likelihood of chronic opioid use than controls during each year after index date. However, breast cancer survivors who were chronic opioid users were more likely to use a high daily dose than chronic users without cancer in the first 3 years after index date, with ORs ranging from 1.32 to 1.85.

The researchers acknowledged limitations to the study, including the inability to ascertain whether chronic opioid use was an indication of appropriate pain management and the inability to exclude patients with progressive or recurrent disease.

“Although more in-depth analyses of treatment-related effects and other cancer groups are warranted, these findings point to the long-term risk of chronic opioid use in older cancer survivors,” the researchers wrote. “Attention should focus on older patients with chronic opioid use, who consistently receive higher doses than their noncancer counterparts.” by Jennifer Byrne

Disclosures: Salz reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Three large populations of older cancer survivors demonstrated varying degrees of chronic opioid use, with colorectal and lung cancer survivors showing higher rates of chronic use 1 year after diagnosis than matched controls without cancer, according to a study published in Journal of Clinical Oncology.

However, by 6 years, survivors appeared no more likely to be chronic users than controls, results showed.

“Cancer survivors may have greater pain management needs, experience greater health risks and have less coordinated care than patients without cancer,” Talya Salz, PhD, assistant attending outcomes research scientist at Memorial Sloan Kettering Cancer Center, and colleagues wrote. “Our study focused on chronic opioid use, which has unclear benefits and is associated with long-term harms, including dependence, overdose and fractures. We investigated whether older cancer survivors of three common cancers were at increased risk for chronic opioid use and high-dose opioid use in the years after cancer treatment, accounting for trends in the general population.”

Salz and colleagues used SEER and Medicare data to conduct multilevel logistic regression analyses of chronic opioid use (90 consecutive days or longer) among survivors of colorectal (n = 13,101), lung (n = 11,859) and breast cancers (n = 21,829). The analysis included patients aged 66 years and older who were diagnosed between 2008 and 2013 and had not received opioids prior to diagnosis.

Researchers matched survivors at diagnosis date (index date) to three noncancer controls based on sex, race, Charlson comorbidity score and birth year. They then compared rates of high-dose opioid use (average 90 morphine mg equivalents or more daily) among cases and controls with chronic use.

Results showed opioid use among matched controls increased as the controls aged, particularly among those matched to patients with breast cancer (2.9% in the first year after index date to 7.3% in the sixth year after index date).

Colorectal cancer survivors demonstrated rates of chronic opioid use ranging from 2% in the first year after diagnosis to 4.3% at 6 years after diagnosis. These survivors appeared more likely than controls to demonstrate chronic opioid use in the first year (OR = 1.34; 95% CI, 1.22-1.47) and second year (OR = 1.17; 95% CI, 1.07-1.29) after diagnosis. The difference did not retain statistical significance by 3 years.

In the first 3 years after diagnosis, colorectal cancer survivors were more likely to have high-dose opioid use than controls, with ORs ranging from 1.79 to 2.61 (all P < .05).

Lung cancer survivors demonstrated the highest unadjusted rates of chronic opioid use vs. other survivor groups in the years after diagnosis and within each calendar year. These survivors also appeared more likely than controls to demonstrate chronic opioid use for the first 5 years after the index date, however, to a diminishing extent from year 1 (OR = 2.55, 95% CI, 2.34-2.77) to year 5 (OR = 1.34; 95% CI, 1.08 to 1.66).

Lung cancer survivors had greater odds of high-dose opioid use during the first 4 years after index date than controls, with ORs of 3.65 to 5.54 (P < .05).

Rates of chronic opioid use among breast cancer survivors ranged from 1.9% in the first year after diagnosis to 3.7% in the sixth year. These survivors demonstrated a lower likelihood of chronic opioid use than controls during each year after index date. However, breast cancer survivors who were chronic opioid users were more likely to use a high daily dose than chronic users without cancer in the first 3 years after index date, with ORs ranging from 1.32 to 1.85.

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The researchers acknowledged limitations to the study, including the inability to ascertain whether chronic opioid use was an indication of appropriate pain management and the inability to exclude patients with progressive or recurrent disease.

“Although more in-depth analyses of treatment-related effects and other cancer groups are warranted, these findings point to the long-term risk of chronic opioid use in older cancer survivors,” the researchers wrote. “Attention should focus on older patients with chronic opioid use, who consistently receive higher doses than their noncancer counterparts.” by Jennifer Byrne

Disclosures: Salz reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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