In the Journals

Opioid-related hospitalizations uncommon, but slowly rising, among patients with cancer

Photo of Isaac Chua
Isaac S. Chua

Opioid-related hospitalizations among patients with cancer in the United States are rare and increasing at a low rate despite the opioid epidemic, according to a research letter published in JAMA Oncology.

“Anecdotally, it is not a surprise that opioid-related hospitalizations in cancer are rare. However, in light of the opioid epidemic, it is also not surprising that the rate of opioid-related hospitalization among patients with cancer is gradually increasing over time,” Isaac S. Chua, MD, of the department of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, told HemOnc Today. “We are increasingly seeing more patients with cancer with substance use disorders who present to our oncology and palliative care clinics.”

Opioids are prescribed to help patients manage cancer-related pain. The most common include morphine, oxycodone, fentanyl, hydromorphone and methadone, Chua said. There is no “usual” dose prescribed because each patient has different needs when it comes to treating pain, he added.

To understand misuse among these patients, clinicians have had to rely upon small, preliminary studies, which have estimated addiction rates as high as 7.7%.

Chua and colleagues took a broader look at trends and risk factors by analyzing 25,004,243 cancer-related hospitalizations between 2006 and 2014 using a national database with deidentified patient information. They identified opioid-related hospitalizations for heroin poisoning, opioid poisoning, and opioid dependence or abuse using International Classification of Diseases, Ninth Revision, diagnosis codes.

The number of opioid-related hospitalizations among adults with cancer served as the primary outcome.

Among all hospitalizations of patients with cancer, 14,095 (0.06%) were related to opioids. Nonheroin opioid poisoning comprised the majority (88%) of opioid-related hospitalizations.

Researchers used a linear regression model to examine trends in opioid-related hospitalizations and observed an average increase from 2006 to 2014 of 78.9 admissions per year, from 1,170 to 1,715 (P = .01). The linear time trend of these hospitalizations increased by an average of 0.003% per year when adjusted for all-cause hospitalizations.

The most common factors associated with opioid-related hospitalizations among patients with cancer included drug abuse (OR = 7.92; 95% CI, 6.95-9.02), depression (OR = 2.34; 95% CI, 2.13-2.58) and psychotic disorders (OR = 4.13; 95% CI, 3.66-4.65), as well as white race, younger age and hospitalization year.

Alcohol abuse was associated with opioid-related hospitalizations, but the correlation was not statistically significant (OR = 1.15; 95% CI, 0.99-1.35).

“Based on our study, one cannot definitively conclude that the lower number of opioid-related hospitalizations among [patients with] cancer is due to prescribing practices among clinicians,” Chua told HemOnc Today. “There needs to be more research on opioid risk screening and management for patients with combined cancer and substance use disorder in order to better understand this phenomenon.” – by John DeRosier

For more information:

Isaac S. Chua, MD, can be reached at Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave., Dana 2016A, Boston, MA 02215-5450; email: isaac_chua@dfci.harvard.edu.

Disclosures: The authors report no relevant financial disclosures.

Photo of Isaac Chua
Isaac S. Chua

Opioid-related hospitalizations among patients with cancer in the United States are rare and increasing at a low rate despite the opioid epidemic, according to a research letter published in JAMA Oncology.

“Anecdotally, it is not a surprise that opioid-related hospitalizations in cancer are rare. However, in light of the opioid epidemic, it is also not surprising that the rate of opioid-related hospitalization among patients with cancer is gradually increasing over time,” Isaac S. Chua, MD, of the department of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, told HemOnc Today. “We are increasingly seeing more patients with cancer with substance use disorders who present to our oncology and palliative care clinics.”

Opioids are prescribed to help patients manage cancer-related pain. The most common include morphine, oxycodone, fentanyl, hydromorphone and methadone, Chua said. There is no “usual” dose prescribed because each patient has different needs when it comes to treating pain, he added.

To understand misuse among these patients, clinicians have had to rely upon small, preliminary studies, which have estimated addiction rates as high as 7.7%.

Chua and colleagues took a broader look at trends and risk factors by analyzing 25,004,243 cancer-related hospitalizations between 2006 and 2014 using a national database with deidentified patient information. They identified opioid-related hospitalizations for heroin poisoning, opioid poisoning, and opioid dependence or abuse using International Classification of Diseases, Ninth Revision, diagnosis codes.

The number of opioid-related hospitalizations among adults with cancer served as the primary outcome.

Among all hospitalizations of patients with cancer, 14,095 (0.06%) were related to opioids. Nonheroin opioid poisoning comprised the majority (88%) of opioid-related hospitalizations.

Researchers used a linear regression model to examine trends in opioid-related hospitalizations and observed an average increase from 2006 to 2014 of 78.9 admissions per year, from 1,170 to 1,715 (P = .01). The linear time trend of these hospitalizations increased by an average of 0.003% per year when adjusted for all-cause hospitalizations.

The most common factors associated with opioid-related hospitalizations among patients with cancer included drug abuse (OR = 7.92; 95% CI, 6.95-9.02), depression (OR = 2.34; 95% CI, 2.13-2.58) and psychotic disorders (OR = 4.13; 95% CI, 3.66-4.65), as well as white race, younger age and hospitalization year.

Alcohol abuse was associated with opioid-related hospitalizations, but the correlation was not statistically significant (OR = 1.15; 95% CI, 0.99-1.35).

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“Based on our study, one cannot definitively conclude that the lower number of opioid-related hospitalizations among [patients with] cancer is due to prescribing practices among clinicians,” Chua told HemOnc Today. “There needs to be more research on opioid risk screening and management for patients with combined cancer and substance use disorder in order to better understand this phenomenon.” – by John DeRosier

For more information:

Isaac S. Chua, MD, can be reached at Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave., Dana 2016A, Boston, MA 02215-5450; email: isaac_chua@dfci.harvard.edu.

Disclosures: The authors report no relevant financial disclosures.

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