Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 May;67(5):945-952.
doi: 10.1111/jgs.15945. Epub 2019 Apr 26.

Long-Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Affiliations
Free PMC article
Multicenter Study

Long-Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Rahul Shah et al. J Am Geriatr Soc. .
Free PMC article

Abstract

Objectives: To examine the rates and predictors of long-term opioid therapy in older cancer survivors.

Design: Retrospective cohort study.

Setting: Texas, United States.

Participants: Cancer survivors (5 years or more postcancer diagnosis) diagnosed from 1995 to 2008 and who were also Medicare Parts A, B, and D beneficiaries.

Measurements: We used Medicare Part D event data to calculate the proportion of cancer survivors with a prolonged opioid prescription (90-day or more supply of opioids/year). Adjusted odds ratios were calculated to identify predictors of prolonged opioid prescribing. All analyses were repeated with a subcohort of opioid-naïve cancer survivors.

Results: The rate of prolonged opioid therapy for cancer patients diagnosed in 2008 was 7.1% prior to cancer diagnosis; it rose to 9.8% within a year of cancer treatments, and to 13.3% at 5 years postdiagnosis. The rate at the sixth year varied by cancer sites: 19.4% in lung cancer and 9.6% in prostate cancer. Among opioid-naïve survivors, the rate increased from 1.4% to 7.1%, from 5 to 18 years postcancer diagnosis. Cancer survivors diagnosed in 2004 to 2008 had higher rates of opioid prescribing compared to those diagnosed in 1995 to 1998 and 1999 to 2003. Years since diagnosis, a later year of diagnosis, female sex, urban location, lung cancer diagnosis, disability as reason for Medicare entitlement, Medicaid eligibility, one or more comorbidity, and history of depression or drug abuse were predictors of prolonged opioid therapy. Among opioid-naïve cancer survivors, diagnosis in 2004 to 2008 was the strongest predictor, while a history of drug abuse was the strongest predictor for all the survivors.

Conclusion: The rates of prolonged opioid prescribing for older cancer survivors remained high at 5 or more years after cancer diagnosis. Our findings have potential to inform the development of clinical guidelines and public policy to ensure safer and more effective pain treatment in older cancer survivors. J Am Geriatr Soc 67:945-952, 2019.

Keywords: cancer survivor; chronic pain; opioid.

Conflict of interest statement

Conflict of Interest: The authors have no financial, personal, or potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Prolonged opioid prescription rate after cancer diagnosis for (A) cancer survivors and (B) opioid naive cancer survivors stratified by year of diagnosis. 5 years since cancer diagnosis means 5–6 years since cancer diagnosis, i.e., for the individuals diagnosed in 2008, the rate at 5 years since diagnosis were the prescriptions during 2013–2014.
Figure 2
Figure 2
Prolonged opioid prescription rate after cancer diagnosis for (A1-A3) cancer survivors and (B1-B3) opioid naive cancer survivors stratified by year of diagnosis and cancer type.
Figure 3
Figure 3
Prolonged opioid prescription rate before and after cancer diagnosis for cancer survivors diagnosed in 2008 (N=6179).

Similar articles

See all similar articles

Cited by 3 articles

Publication types

Substances

Feedback