Opioid Use Declining in US Cancer Patients

Opioid use is declining in American cancer patients but at a lower rate than in patients without cancer, according to a study published in the Journal of the National Cancer Institute.

This study included SEER-Medicare data from 238,470 patients diagnosed with solid tumor malignancies from 2012 through 2017 as well as 289,914 patients without cancer.

In the cancer cohort, 13.6% of patients had metastatic cancer, 18.6% had non-metastatic disease treated with surgery alone, and 11.2% had non-metastatic cancer treated with surgery and other therapies. The most common cancers were breast (22%), lung (21%), prostate (19%), and colorectal (13%) cancer.

The proportion of patients with a new opioid prescription within 90 days of the index date was 46.4% in the cancer cohort and 6.9% in the cancer-free cohort (P <.001).

Among the cancer patients, the proportion with a new opioid prescription was 50.0% in the group with metastatic cancer, 59.1% in the group treated with surgery alone, and 70.8% in those treated with surgery and other therapies.

The researchers noted that new opioid use declined over time, but the decline was greater among patients without cancer than among those with cancer (P <.001).

From 2012 to 2017, the predicted probability of new opioid use decreased:

• 20.0% in the patients without cancer (from 7.7% to 6.2%; P <.001)
• 8.8% in patients with metastatic cancer (from 52.1% to 47.5%; P <.001)
• 0.1% in cancer patients treated with surgery alone (from 58.5% to 58.4%; P =.97)
• 2.4% in cancer patients treated with surgery and other therapies (from 69.9% to 68.2%; P =.10).

The researchers also evaluated early additional opioid use, which was defined as any opioid prescription in the 90 days after the index date with an additional prescription during days 91-180.

Among patients who had a new opioid prescription, additional use was seen in 29.0% of patients without cancer, 24.2% of patients with cancer, 31.7% of patients with metastatic cancer, 18.4% of cancer patients treated with surgery alone, and 23.5% of cancer patients treated with surgery and other therapies (P <.001).

From 2012 to 2017, the predicted probability of additional opioid use decreased:

• 18.4% in the patients without cancer (from 31.4% to 25.6%; P <.001)
• 2.8% in patients with metastatic cancer (from 31.6% to 30.8%; P =.50)
• 14.9% in cancer patients treated with surgery alone (from 20.3% to 17.3%; P <.001)
• 17.5% in cancer patients treated with surgery and other therapies (from 25.9% to 21.4%; P <.001).

The researchers also looked at long-term opioid use, which was defined as any opioid prescription in the initial 90 days, at least 1 prescription during days 91-180, and at least 1 prescription within a 90-day period starting 1 year after the index date.

Among patients who had a new opioid prescription, long-term opioid use was seen in 13.2% of patients without cancer, 8.0% of patients with cancer, 5.2% of cancer patients treated with surgery alone, and 6.8% of cancer patients treated with surgery and other therapies (P <.001). Patients with metastatic disease were excluded from this analysis due to the high rate of death in this group.

From 2012 to 2017, the predicted probability of long-term opioid use decreased:

•  30.5% in the patients without cancer (from 15.4% to 10.7%; P <.001)
•  39.0% in cancer patients treated with surgery alone (from 6.5% to 4.0%; P <.001)
•  47.6% in cancer patients treated with surgery and other therapies (from 9.2% to 4.8%; P <.001).

“Amid national efforts to curb opioid use, non-cancer and curative-intent cancer patients showed substantial decreases in additional opioid use, with steeper downward trends in patients without cancer for early additional use, but similar downward trends in long-term additional use,” the researchers summarized. “Further research is needed to evaluate patient-level impact and to establish best practices for opioid prescribing for patients with cancer.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Van Metre Baum L, Madhav KC, Soulos PR, et al. Trends in new and persistent opioid use in older adults with and without cancer. J Natl Cancer Inst. Published online October 6, 2023. doi:10.1093/jnci/djad206

This article originally appeared on Cancer Therapy Advisor