Patients with cancer who undergo curative-intent surgery for cancer are at risk of iatrogenic new persistent opioid-use, according to a study published in the Journal of Clinical Oncology.1

The modern opioid epidemic is forcing health care providers and government agencies to reevaluate pain management, but there is a lack of data regarding the risk of opioid-misuse among vulnerable populations.

For this retrospective study, researchers accessed a market research database of insurance claims to review the data of 68,463 patients with cancer who underwent curative-intent surgery and filled an opioid prescription between 2010 and 2014.

First-time opioid users had a 10.4% (95% CI, 10.1%-10.7%) risk of persistent opioid use, and even after 1 year of surgery, patients continued to take opioids at dosages similar to those of chronic opioid users (P = .05), which is approximately a total daily dose of hydrocodone 30 mg.

Patients who received adjuvant chemotherapy took opioids at increased doses (P = .002), but even patients who did not undergo chemotherapy took doses of opioids similar to chronic opioid users.

Multivariate analysis of curative-intent procedures revealed that the persistent new opioid-use risk among patients who received adjuvant chemotherapy was 15% to 21%, while the risk for patients who do not receive chemotherapy was 7% to 11%.

The authors concluded that this “problem requires changes to prescribing guidelines and patient counseling during surveillance and survivorship phases of care.”

Reference

  1. Lee JS, Hu HM, Edelman AL, et al. New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol. 2017 Oct 19. doi: 10.1200/JCO.2017.74 [Epub ahead of print]