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Patient-level factors associated with chronic opioid use in cancer: a population-based cohort study

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Abstract

Purpose

Concerns around chronic opioid use (COU), misuse, and harms have led to increased scrutiny of opioid prescribing in oncology. There is lack of research examining patient-level factors associated with COU. Our aim was to examine patient-level factors associated with COU in newly diagnosed cancer patients.

Methods

Population-based retrospective cohort study using administrative health data of patients in Alberta, Canada, diagnosed between February 2016 and October 2017. Adult cancer patients who completed a symptom survey within ± 60 days of diagnosis were included. Patients were divided into two groups: COU (defined as continuous opioid prescriptions for at least 90 days post-diagnosis) and non-chronic opioid use (NCOU). Logistic regression was used to evaluate factors associated with COU.

Results

We included 694 patients (mean age 65 years; 51% female). Most had breast (20%), colorectal (13%), and lung (33%) cancers. Of the 14% with COU, 79% were opioid naïve at diagnosis. Those in the COU group were more often diagnosed with advanced cancer (66% versus 40%), had lung cancer (47%), and were opioid tolerant (> 90 days of continuous opioids within one-year pre-diagnosis). A total of 64% of COU versus 27% of NCOU had moderate to severe pain at diagnosis (p < 0.001). Irrespective of treatment type or stage, those with moderate to severe pain, were opioid tolerant at diagnosis, or had multiple prescribers were at greater risk for COU.

Conclusions

Specific patient groups were at increased risk of COU and should be the focus of adaptive prescribing approaches to ensure that opioid use is appropriate.

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Author information

Authors and Affiliations

  1. Faculty of Nursing, University of Calgary, PF 2294, 2500 University Drive N.W, Calgary, AB, T2N 1N4, Canada

    Colleen A. Cuthbert

  2. Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada

    Yuan Xu, Shiying Kong, Devon J. Boyne & Brenda R. Hemmelgarn

  3. Department of Medicine, University of Calgary, Calgary, Canada

    Brenda R. Hemmelgarn

  4. Alberta Health Services Cancer Control, Calgary, Alberta, Canada

    Winson Y. Cheung

  5. Cumming School of Medicine, Department of Oncology, University of Calgary, Calgary, Canada

    Winson Y. Cheung

Authors
  1. Colleen A. Cuthbert
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  2. Yuan Xu
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  3. Shiying Kong
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  4. Devon J. Boyne
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  6. Winson Y. Cheung
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Corresponding author

Correspondence to Colleen A. Cuthbert.

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This study received approval from the Health Research Ethics Board of Alberta (HREBA.CC-17-0238).

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The authors declare that they have no conflict of interest.

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Cuthbert, C.A., Xu, Y., Kong, S. et al. Patient-level factors associated with chronic opioid use in cancer: a population-based cohort study. Support Care Cancer 28, 4201–4209 (2020). https://doi.org/10.1007/s00520-019-05224-y

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  • DOI: https://doi.org/10.1007/s00520-019-05224-y

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