Opioid Use Among Older Survivors of Colorectal, Lung, and Breast Cancers
In a linked Surveillance, Epidemiology, and End Results and Medicare study reported in the Journal of Clinical Oncology, Salz et al found that chronic opioid use varied by cancer among older cancer survivors. By 6 years after diagnosis, survivors were no more likely to be chronic opioid users compared with controls with no history of cancer, partly reflecting increased chronic use among control group patients.
The study involved data from 46,789 opioid-naive survivors of colorectal, lung, and breast cancers diagnosed from 2008 to 2013, and 138,136 matched noncancer controls. Chronic opioid use was defined as use for ≥ 90 consecutive days. Rates of high-dose opioid use defined as an average of ≥ 90 morphine milligram equivalents daily were compared among cases and controls with chronic use.
Chronic Use
In the first year after the index date (ie, survivor’s diagnosis date), chronic use among survivors vs controls was significantly higher among colorectal cancer survivors (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.22–1.47) and lung cancer survivors (OR = 2.55, 95% CI = 2.34–2.77). Differences in chronic use between survivors and controls declined each year after the index date. For lung cancer survivors vs controls, chronic use was 5.3% vs 2.1 % for year 1; 6.9% vs 3.4% for year 2; 6.9% vs 4.2% for year 3; 6.9% vs 5.0% for year 4; 7.7% vs 5.8% for year 5; and 7.4% vs 6.7 for year 6 (years 1–5 statistically significant).
For colorectal cancer survivors, chronic use for the corresponding years was 2.7% vs 2.0%; 3.8% vs 3.2%; 4.1% vs 4.0%; 4.3% vs 4.6%; 4.5% vs 4.9%; and 4.0 vs 4.3% (years 3–6 not statistically significant). Chronic use among breast cancer survivors was less than that of controls each year after the index date, ranging from 1.9% to 3.9% vs 2.9% to 7.3% (all years significantly lower in lung cancer survivors).
Compared with matched controls, high-dose chronic use was more common among breast cancer survivors for the first 3 years, for lung cancer survivors for the first 4 years, and for colorectal cancer survivors for the first 5 years.
The investigators concluded, “Among three large populations of older cancer survivors, chronic opioid use varied by cancer. However, by 6 years after diagnosis, survivors were no longer more likely to be chronic users than controls. Strategies for appropriate pain management during and after cancer treatment should take into account the risks associated with chronic high-dose opioid use.”
Talya Salz, PhD, of the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Chanel Endowment for Survivorship Research at Memorial Sloan Kettering Cancer Center and a grant from the National Institutes of Health. The study authors' full disclosures can be found at jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
