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2018 Quality Care: Opioid Deaths Are 10 Times Less Likely to Occur in Patients With Cancer Compared to the General Population

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Key Points

  • Patients with cancer are 10 times less likely to have deaths attributed to opioid use than those in the general population.
  • Although there was a slight increase in opioid death in patients with cancer, overall, there was not the sharp increase seen in the general population.
  • Patients with cancer at risk for opioid overdose are different than those at risk in the general population and care should be taken when planning effective treatment for cancer-related pain.

According to the U.S. Department of Health and Human Services, in 2016, over 42,000 Americans died from opioid overdose, making the epidemic a top public health concern. Although opioids are commonly used for cancer-associated pain, the risks for overdose in patients with cancer were unknown. A 10-year retrospective study by Chino et al examining the number of opioid deaths among patients with cancer has found patients with cancer were 10 times less likely to die from opioid use than those in the general population. Of the deaths that did occur in patients with cancer from opioid use, those with lung, gastrointestinal, head and neck, hematologic, and genitourinary cancers had the highest percentage. The study will be presented during ASCO’s 2018 Quality Care Symposium, to be held September 28–29 in Phoenix (Abstract 230).

Study Methodology

To determine the number of opioid deaths among patients with cancer, the researchers evaluated death certificates from 2006–2016 from the Centers for Disease Control and Prevention National Center for Health Statistics in which opioids were listed as the primary cause of death and cancer was noted as a contributing cause. Opioid death incidence was calculated from both the United States and estimated cancer survivor population. Chi and R squared tests assessed for differences.

Study Results

The researchers found from 2006–2016, there were 895 deaths from opioids in patients with cancer compared to 193,500 in the general population. Opioid deaths increased from 5.33 to 8.97 per 100,000 people in the general population (significant time trend, P < .001, polynomial fit, R2 0.99). Opioid deaths increased in the cancer population from 0.52 to 0.66 per 100,000 (significant time trend, P < .001, linear fit, R2 0.24, slope = 0.018). Patients with cancer who died due to opioid use were different from those who died due to opioids in the general population, including higher education (12.7% vs 6.9% at least a college degree), more women (38.5% vs 29.2%), fewer whites (82.3% vs 84.2%), more non-Hispanics (94.5% vs 91.3%), and fewer single patients (24.2% vs 48.1%) (all P < .001, except race P = .027). Patients with cancer were also older (median 57 years, IQR 50–65 vs median 42 years, IQR 31–51).

The researchers also found that 22% of opioid deaths were in patients with lung cancer, followed by gastrointestinal (21%), head & neck (12%), hematologic (11%), and genitourinary cancers (10%).

“Death from opioids as the primary cause noted on death certificates are 10 times less likely to occur in [patients with] cancer vs the general population. There was a slight increase in opioid deaths in [patients with] cancer, however, overall, there was not the sharp growth seen in the general population. Patients [with cancer] at risk for opioid overdose are different than those at risk in the general population and care should be taken when planning effective treatment of cancer-related pain,” concluded the study authors.

Prescribing With Caution

“There’s now solid evidence to suggest that people with cancer are at a lower risk of death related to opioid use than the general population, which is important information for physicians to have as they prescribe pain treatment for their patients,” said William Dale, MD, PhD, ASCO expert and member of the Quality Care Symposium New Planning Team, in a statement. “At the same time, opioids can be addictive, so we should find alternatives and welcome new approaches to reduce their use, especially immediately after surgery. Essentially, we need to balance the need for opioids in patients with cancer that have high symptom burdens with the dangers of overdosing when we consider policies and use them thoughtfully.”

To see a full list of author disclosures, refer to the study abstract.

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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