In a study reported in a research letter in JAMA Oncology, Fumiko Chino, MD, and colleagues found that while the incidence of opioid-related death has increased in both the general population and in patients with cancer in recent years, opioid-related death is far less common among individuals with cancer.
Fumiko Chino, MD
Study Details
The study used data from the National Center for Health Statistics (NCHS) to calculate the incidence of opioid-related death in the general U.S. population and in the estimated population of cancer survivors from 2006 to 2016. NCHS death certificates identify a single underlying cause of death and also list contributing factors; those listing cancer as a contributing factor were used to estimate the number of patients with cancer and an opioid-related death.
Key Findings
From 2006 through 2016, there were 193,500 opioid-related deaths in the general population and 895 with cancer as a contributing cause.
Over this time, the incidence of opioid-related deaths increased from 5.33 to 8.97 per 100,000 persons in the general population (P < .001) and from 0.52 to 0.66 per 100,000 in the cancer population (P < .001). In absolute numeric terms, based on NCHS data, the number of such deaths increased between 2006 and 2016 from 15,890 in a general population of 298.4 million to 29,003 in a general of population of 324.4 million, and from 59 in an estimated cancer population of 11.4 million to 102 in an estimated cancer population of 15.5 million.
Compared with the general population, patients with cancer with opioid-related death:
- Were older (median age = 57 vs 42 years, P < .001)
- Had a higher level of education (12.7% vs 6.9% with at least a college degree; overall P < .001 for education level distribution)
- Were more likely to be women (38.5% vs 29.2%; overall P < .001 for sex distribution)
- Were less likely to be white (82.3% vs 84.2%; overall P = .03 for race distribution)
- Were more likely to be non-Hispanic (94.5% vs 90.7%; overall P < .001 for ethnicity distribution)
- Were less likely to be single (24.2% vs 48.1%; overall P < .001 for marital status distribution).
Among the 895 persons with cancer with opioid-related death, the most common underlying primary cancers were lung (22.3%), gastrointestinal (20.9%), head and neck (11.7%), and hematologic (11.3%) cancers.
The investigators stated, “Death from opioids as the primary cause as documented in death certificates is 10 times less likely to occur in cancer survivors vs the general population. In the past decade, there was a slight increase in opioid-related deaths in cancer survivors; however, it was not the sharp growth seen in the general population. These findings confirm prior research showing that opioid-related hospitalizations among patients with cancer are rare but slowly increasing over time…. [T]his may be because of increased survivorship rates with commensurately higher rates of chronic pain or increased abuse of opioid medications.”
They concluded: “[O]pioid-related deaths in the cancer population are much rarer than in the general population. Continued care should be taken when treating cancer-related pain.”
Dr. Chino, of the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
