Ontario Province–Wide Symptom Screening and Opioid Prescribing Rates in Older Patients With Cancer

Key Points

  • Increased use of pain assessment has not been accompanied by increased opioid prescription in patients with severe pain.
  • An annual 5% relative decrease in the odds of receiving an opioid prescription occurred from 2009 to 2013.

In a study reported in the Journal of Oncology Practice, Barbera et al found that a province-wide effort to improve symptom screening and management has increased the frequency of screening but has not improved opioid prescription rates in elderly cancer patients with severe pain. A previous study in Ontario indicated that 33% of cancer patients with severe pain did not receive opioids at the time of their pain assessment.

Study Details

The study cohort consisted of Ontario residents aged ≥ 65 years with a cancer history who were eligible for the government pharmacare program and had pain assessment on the Edmonton Symptom Assessment System (ESAS). Begun in 2007, the ESAS is part of an Ontario initiative to screen ambulatory cancer patients for symptoms. For the years 2007 to 2013, the date of a patient’s highest pain score was considered the index date for calculating annual opioid prescription rates for claims within 30 days before and up to 7 days after the index date.

Screening and Prescriptions

There was increased use of the ESAS over time, with the number of patients screened increasing more than 8-fold between 2007 (n = 4,957) and 2013 (n = 43,715). Extension of the use of the ESAS during this period beyond patients with lung cancer and those in palliative care contributed to a reduction in the proportion of patients with severe pain from 21.2% to 11.5%.

Opioid prescription rates were directly related to pain scores; however, the prescription rate decreased from 31.7% to 13.6% among all patients and from 60.9% to 39.2% among those with severe pain over the study period. Overall, there was an annual 5% relative decrease in the odds of receiving a prescription from 2009 to 2013.

The investigators concluded: “We are doing better at screening for pain, but this has not led to an increase in analgesic intervention for those identified. Additional work is required to determine what opioid prescribing rate is optimal to ensure we are not missing opportunities to improve patient comfort.”

The study was supported by the Ontario Institute for Cancer Research, through funding from the Government of Ontario and from the Institute for Clinical Evaluative Sciences.

Lisa Barbera, MD, of the Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, is the corresponding author of the Journal of Oncology Practice article.

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®.


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