Curative-intent surgery for patients with early-stage cancer led to new, persistent, long-term opioid use in more than 1 in 10 opioid-naive veterans, according to the results of an observational study published in Cancer. The results of the study highlighted how necessary it is to develop new pain management strategies for patients with cancer to minimize opioid-related health risks.
“Minimizing opioid exposure associated with cancer treatment while providing effective pain control will decrease long-term health risks among cancer survivors,” said lead author Marilyn M. Schapira, MD, MPH, of the University of Pennsylvania. “This is important, as many patients are living longer after a cancer diagnosis and treatment.”
Rationale and Study Methods
Any exposure to opioids during cancer treatment may increase the potential for unsafe long-term opioid habits and health risks.
Researchers conducted a retrospective cohort study among U.S. veterans, using data from the Veterans Affairs Corporate Data Warehouse database, to determine the rates of co-prescription of benzodiazepine and opioids as well as that of new, persistent opioid use after surgical treatment of early-stage cancer. All participating veterans (n = 9,213) were aged 21 or older and naive to opioids prior to a diagnosis of stage 0 to III cancer between January 2015 and December 2016.
Key Study Findings
A total of 4% percent of veterans were co-prescribed benzodiazepines and opioids within 13 months of surgery. New, persistent opioid use occurred in 10.6% of participants. When the investigators adjusted for patient, clinical, and geographic factors in a linear model, participants in the higher quartile had more days with co-prescription of benzodiazepines and opioids compared with those with no exposure (mean difference, 1.0; 95% confidence interval [CI] = 0.3–1.7).
A time analysis showed that participants in the highest quartile of total morphine milligram equivalent exposure had a greater risk for new, persistent opioid use compared with those with no exposure (hazard ratio [HR] = 1.6; 95% CI = 1.3–1.9).
People with a history of chronic pain, greater comorbidities, and lower socioeconomic status, as well as those who received adjuvant chemotherapy, were all at higher risk for opioid use in the year after surgery.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
