New Persistent Opioid Use After Curative-Intent Cancer Surgery

Key Points

  • Overall, approximately 10% of patients undergoing curative-intent surgery for cancer became new persistent opiate users.
  • On an adjusted analysis, the risk of new persistent opioid use was higher among patients receiving adjuvant chemotherapy.

A study reported by Lee et al in the Journal of Clinical Oncology indicates that approximately 10% of patients undergoing curative-intent surgery for cancer become new persistent opioid users.

Study Details

The study involved data from 68,463 patients from a national data set of insurance claims (Truven Health Marketscan Research Databases) who underwent curative-intent surgery for melanoma or breast, colorectal, lung, esophageal, or hepatopancreatobiliary/gastric cancers between 2010 and 2014 and filled opioid prescriptions. New persistent opioid use was defined as continued filling of opioid prescriptions 90 to 180 days after surgery among opioid-naive patients. Overall, 39,877 patients (58%) were opioid-naive.

New Persistent Opioid Use

Among opioid-naive patients, new persistent opioid use was identified in 10.4%. At 1 year after surgery, these patients continued filling prescriptions with daily doses similar to those among chronic opioid users (18% of the cohort; P = .05), with use equivalent to six tablets of 5-mg hydrocodone. Daily doses were slightly higher among patients receiving vs not receiving adjuvant chemotherapy (33% of new persistent users; P = .002), with those not receiving adjuvant chemotherapy having an average daily dose equivalent to five tablets of 5-mg hydrocodone. In an analysis adjusting for relevant covariates, an adjusted risk of new persistent opioid use across different types of cancer surgeries was 15% to 21% in patients receiving adjuvant chemotherapy and 7% to 11% in those not receiving adjuvant chemotherapy.

The investigators concluded: “New persistent opioid use is a common iatrogenic complication in patients with cancer undergoing curative-intent surgery. This problem requires changes to prescribing guidelines and patient counseling during the surveillance and survivorship phases of care.”

The study was supported by the National Institute on Drug Abuse, Michigan Department of Health and Human Services, and others.

Lesly A. Dossett, MD, MPH, of the Division of Surgical Oncology, University of Michigan, Ann Arbor, is the corresponding author of the Journal of Clinical Oncology 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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