Opioid analgesics prescription in people with and without cancer in France

Asmaa Janah, PhD Candidate; Anne-Déborah Bouhnik, PhD; Sébastien Cortaredona, MSc; Julien Mancini, MD, PhD; Philippe Jean Bousquet, MD, PhD; Patrick Peretti-Watel, PhD; Marc-Karim Bendiane, MSc

doi:10.5055/jom.2018.0456

Authors

Asmaa Janah, PhD Candidate
Anne-Déborah Bouhnik, PhD
Sébastien Cortaredona, MSc
Julien Mancini, MD, PhD
Philippe Jean Bousquet, MD, PhD
Patrick Peretti-Watel, PhD
Marc-Karim Bendiane, MSc

DOI:

https://doi.org/10.5055/jom.2018.0456

Keywords:

cancer, survivors, pain, WHO analgesic ladder, opioid analgesics, health insurance reimbursement

Abstract

Introduction and Objectives: According to World Health Organization recommendations, opioids prescription is a key aspect of improvement in cancer pain relief. However, studies on opioids prescription in France are scarce. This study aimed principally to investigate the impact of cancer on opioids prescription and then to identify factors associated with this prescription, focusing on patients' characteristics impact.

Methods: We matched the following two cohorts: cancer survivors (N = 6,760) and individuals without cancer (N = 6,760). Using French health insurance databases, we compared the prevalence of prescribed opioids in 2009-2015 in people with and without cancer and we applied afterwards conditional Poisson regressions to estimate relative risks for monthly opioids prescription. For cancer survivors only (N = 3,055), multivariate negative binomial regressions were performed to identify factors associated with opioids prescription.

Results: Cancer was associated with a higher analgesics prescription in the cancer population. While Step II and III opioids prescription decreased over time, the latter remained marginal and tended to stabilize. Older people were most adversely affected by underprescription of opioids, especially Step III opioids. Furthermore, although the matched case/control study suggested that men were prescribed opioids more often than women, multivariate analysis did not support this finding.

Conclusion: The inconsistency between our findings and existing literature regarding both opioids prescription trends and postdiagnosis pain chronicity in cancer survivors over the medium term suggests possible changes in pain perception and the evolution of cancer pain management strategies. Further research should explore these hypotheses and investigate patient characteristics' effect in cancer pain management.

Author Biographies

Asmaa Janah, PhD Candidate

Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France

Anne-Déborah Bouhnik, PhD

Research Engineer and Biostatistician, Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France

Sébastien Cortaredona, MSc

Research Engineer and Biostatistician, Aix Marseille Univ, INSERM, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, France

Julien Mancini, MD, PhD

Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France; BiosTIC, La Timone Hospital, APHM, Marseille, France

Philippe Jean Bousquet, MD, PhD

Data Monitoring, Survey and Assessment Department, French National Cancer Institute (INCa), Boulogne Billancourt, France

Patrick Peretti-Watel, PhD

Researcher and Sociologist, Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHUMéditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, France

Marc-Karim Bendiane, MSc

Researcher and Sociologist, Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France; ORS PACA, South-Eastern Health Regional Observatory, Marseille, France

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