In a study in residents of rural southwest Virginia reported in the Journal of Oncology Practice, Virginia T. LeBaron, PhD, and colleagues found that most patients with cancer never received a prescription opioid medication, that few patients were admitted to hospital for opioid use disorders, and that there was no difference in risk for opioid-related hospitalization according to frequency of prescription opioid medication prescriptions.
Virginia T. LeBaron, PhD
As noted by the investigators, southwest Virginia—in central Appalachia—is one of the regions in the United States where both disproportionately high cancer mortality and opioid fatality rates are present.
Study Details and Findings
The study involved data on 4,324 adult patients living with cancer in rural southwest Virginia between 2011 and 2015 obtained from the Commonwealth of Virginia All Payer Claims Database.
Among all patients, < 25% were prescribed a controlled substance schedule II (C-II) prescription opioid medication three or more times in any study year.
More than 60% of patients never received a C-II prescription opioid medication prescription. The investigators observed that this finding is consistent with findings in other studies indicating undertreatment of pain in patients with cancer.
Between 2011 and 2015, a total of 652 patients (15%) had 1,599 hospitalizations for any reason, with 10 or fewer patients having 11 opioid use disorder-related hospitalizations.
“The main findings suggest potential undertreatment of cancer-related pain; no difference in risk for opioid-related hospitalization on the basis of frequency of prescription opioid medication prescriptions; and geographic disparities where opioid overdoses are occurring vs where prescription opioid medication prescription use is highest."— LeBaron et al
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There was no difference between patients receiving one or two prescription opioid medication prescriptions per year vs those receiving three or more in number of opioid use disorder-related hospitalizations.
County-level disparities were found regarding the highest number of C-II authorized prescribers and the highest rates of fatal prescription opioid medication overdose. It was observed that one county had both the highest prescription opioid medication overdose rate and the lowest malignant cancer incidence; the investigators stated that this finding suggests that patients with cancer do not drive the county’s high incidence of prescription opioid medication overdose.
The investigators concluded, “The main findings suggest potential undertreatment of cancer-related pain; no difference in risk for opioid-related hospitalization on the basis of frequency of prescription opioid medication prescriptions; and geographic disparities where opioid overdoses are occurring vs where prescription opioid medication prescription use is highest…these findings have significant opioid policy and practice implications related to the need for cancer-specific prescribing guidelines, how to optimally allocate health delivery services, and the urgent need to improve data interoperability and access related to prescription opioid medications.”
Dr. LeBaron, of the University of Virginia School of Nursing, Charlottesville, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: The study was supported by the University of Virginia Cancer Center, Cancer Control & Population Health Division and the Virginia Tobacco Region Revitalization Commission. For full disclosures of the study authors, visit jop.ascopubs.org.
