Patterns and Trends in Receipt of Opioids Among Patients Receiving Treatment for Cancer in a Large Health System
Background: Given limited evidence on opioid prescribing among patients receiving treatment for cancer during the ongoing opioid epidemic, our objective was to assess predictors of and trends in opioid receipt during cancer treatment, including how patterns differ by type of cancer. Methods: Using cancer registry data, we identified patients with a first lifetime primary diagnosis of breast, colorectal, or lung cancer from 2013 to 2017 who underwent treatment within a large cancer center network. Cancer registry data were linked to electronic health record information on opioid prescriptions. We examined predictors of and trends in receipt of any opioid prescription within 12 months of cancer diagnosis. Results: The percentage of patients receiving opioids varied by cancer type: breast cancer, 35% (1,996/5,649); colorectal, 37% (776/2,083); lung, 47% (1,259/2,654). In multivariable analysis, opioid use in the year before cancer diagnosis was the factor most strongly associated with receipt of opioids after cancer diagnosis, with 4.90 (95% CI, 4.10–5.86), 5.09 (95% CI, 3.88–6.69), and 3.31 (95% CI, 2.68–4.10) higher odds for breast, colorectal, and lung cancers, respectively. We did not observe a consistent decline in opioid prescribing over time, and trends differed by cancer type. Conclusions: Our findings suggest that prescription of opioids to patients with cancer varies by cancer type and other factors. In particular, patients are more likely to receive opioids after cancer diagnosis if they were previously exposed before diagnosis, suggesting that pain among patients with cancer may commonly include non–cancer-related pain. Heterogeneity and complexity among patients with cancer must be accounted for in developing policies and guidelines aimed at addressing pain management while minimizing the risk of opioid misuse.
Submitted May 4, 2021; final revision received September 1, 2021; accepted for publication October 18, 2021. Published online March 1, 2022.
Author contributions: Study concept and design: Sabik, Schenker. Data acquisition and analysis: Sabik, Sun, Eom. Data interpretation: All authors. Writing – original draft: Sabik. Critical revision: All authors.
Disclosures: Dr. Merlin has disclosed receiving grant/research support from the Cambia Health Foundation. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by the University of Pittsburgh Medical Center Hillman Cancer Center Developmental Funding Program through the NCI of the NIH under award number P30CA047904 (Y. Schenker) and the Palliative Research Center at the University of Pittsburgh. It was also supported by the National Center for Advancing Translational Sciences of the NIH under award number KL2TR001856 (H.W. Bulls). Data were provided by University of Pittsburgh Medical Center Registry Services and the University of Pittsburgh’s Health Record Research Request (R3) service supported by the NIH through grant UL1 TR001857.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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