Opioid Use Increased Among Cancer Survivors

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Opioid prescriptions were significantly higher among cancer survivors compared with controls, even years after attaining survivorship, according to data from a study published in Cancer.

“Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use in order to differentiate chronic pain from dependency, as well as explore alternative methods for pain control, such as physical therapy, exercise, and acupuncture,” wrote Rinku Sutradhar, PhD, of the University of Toronto in Canada, and colleagues. “Our study emphasizes the need for survivors of cancer to be cared for by providers that are able to give supportive cancer care and are experienced in holistic approaches for managing chronic pain.”

The retrospective study looked at 8,601 people residing in Ontario, Canada aged 18 to 64 who were at least 5 years from their cancer diagnosis in 2010. These individuals were matched to control patients without a prior cancer diagnosis.

The median time since cancer diagnosis was 10 years. The researchers calculated a crude rate of opioid prescriptions for survivors and found that it was 1.22 time higher than that of matched controls (95% CI, 1.209–1.232). This increased rate remained even after multivariable adjustment.

“It should be noted that all survivors were free of cancer recurrence or second malignancy (and all corresponding controls were free of cancer) during their period of follow-up,” the researchers wrote. “A higher prescribing rate persisted, even for survivors who were 10 or more years past their cancer diagnosis.”

Certain populations were more likely to have higher prescribing rates including those who were younger, from rural neighborhoods, and those with more comorbidities. However, sex was not associated with prescribing rates.

In addition, survivors of lung, gynecological, other gastrointestinal, or other genitourinary cancers had significantly higher rates of opioid prescribing compared with their matched controls.

At the end of a 3-year period, the mean cumulative number of opioid prescriptions filled by cancer survivors was 7.7 compared with 6.3 in controls (P < .0001).

The researchers suggested several possible explanations that might contribute to their findings.

“The prevalence of chronic pain among survivors may be higher, and may remain higher over time compared with the prevalence of chronic pain in the general population with no history of cancer,” they wrote. “Survivors may experience long-term sequelae related to their diagnosis or treatment that cause persistent pain.... It is also possible that a higher rate of opioid prescribing among survivors is due to a dependency that originated from opioid use earlier in the disease trajectory.”