Opioid utilization patterns among patients with cancer and non-cancer pain
Keywords:opioid use, opioid dose, cancer pain, non-cancer pain
Objective: Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations.
Design: Retrospective analysis of administrative claims data.
Setting: HealthCore Integrated Research Environment database.
Patients: Adults with ≥1 opioid pharmacy claim (and a confirmed cancer diagnosis for the cancer pain cohort).
Main outcome measures: Opioid doses and dose changes following the initial prescribed (index) dose were determined.
Results: In the cancer pain (n = 9,209) and non-cancer pain (n = 409,703) cohorts, median index opioid doses were 51.7 and 45.0 morphine-equivalent units (MEU), respectively, and median post-index opioid doses were 55.8 and 45.1 MEU for the cancer pain and non-cancer pain cohorts, respectively. The most common dose escalation in both groups was up to a dose doubling (cancer pain, 31.8 percent; non-cancer pain, 28.3 percent). The proportions of patients with dose increases exceeding two times the index dose were low and clinically comparable between cohorts (cancer pain, 9.9 percent; non-cancer pain, 7.4 percent).
Conclusions: Opioid use was consistent between patients with cancer pain and non-cancer pain, including clinically comparable total daily opioid doses and consistent rates of dose escalations and chronic utilization. Opioid medications are an important element of cancer and non-cancer pain management; thus, access to appropriate therapies, use patterns, and risk assessment and management are important for both patient populations.
Manchikanti L, Kaye AM, Knezevic NN, et al.: Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2017; 20(2S): S3-S92.
Portenoy RK, Ahmed E: Principles of opioid use in cancer pain. J Clin Oncol. 2014; 32(16): 1662-1670.
Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.
Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645.
World Health Organization: Cancer Pain Relief: With a Guide to Opioid Availability. 2nd ed. Geneva, Switzerland: World Health Organization, 1996.
Portenoy RK, Sibirceva U, Smout R, et al.: Opioid use and survival at the end of life: A survey of a hospice population. J Pain Symptom Manage. 2006; 32(6): 532-540.
Miller KD, Siegel RL, Lin CC, et al.: Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016; 66(4): 271-289.
Brown M, Farquhar-Smith P: Pain in cancer survivors; filling in the gaps. Br J Anaesth. 2017; 119(4): 723-736.
Bennett M, Paice JA, Wallace M: Pain and opioids in cancer care: Benefits, risks, and alternatives. Am Soc Clin Oncol Educ Book. 2017; 37: 705-713.
Foley KM: The treatment of pain in the patient with cancer. CA Cancer J Clin. 1986; 36(4): 194-215.
Glare PA, Davies PS, Finlay E, et al.: Pain in cancer survivors. J Clin Oncol. 2014; 32(16): 1739-1747.
Hamood R, Hamood H, Merhasin I, et al.: Chronic pain and other symptoms among breast cancer survivors: Prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018; 167(1): 157-169.
Malhotra VT, Glare P, Tan KS, et al.: The tri-institutional pain registry-analysis of outpatient pain management at a specialized cancer center. Pain Med. 2017; 18(12): 2474-2484.
Ziegler L, Mulvey M, Blenkinsopp A, et al.: Opioid prescribing for patients with cancer in the last year of life: A longitudinal population cohort study. Pain. 2016; 157(11): 2445-2451.
Al Achkar M, Revere D, Dennis B, et al.: Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: A qualitative study in Indiana. BMJ Open. 2017; 7(11): e015083.
Paice JA, Portenoy R, Lacchetti C, et al.: Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016; 34(27): 3325-3345.
National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Adult Cancer Pain. Version 2.2017. May 10, 2017. Available at https://www.nccn.org/professionals/physician_gls/pdf/pain.pdf. Accessed May 10, 2017.
Datto CJ, Hu Y, Wittbrodt E, et al.: Cancer and non-cancer pain opioid utilization in Medicare and Medicaid populations. J Clin Oncol. 2018; 36(7 suppl): 139.
Zin CS, Rahman NA, Ismail CR, et al.: Dose and duration of opioid use in patients with cancer and noncancer pain at an outpatient hospital setting in Malaysia. Pain Pract. 2017; 17(6): 774-781.
US Food and Drug Administration: Statement by FDA Commissioner Scott Gottlieb, M.D., on balancing access to appropriate treatment for patients with chronic and end-of-life pain with need to take steps to stem misuse and abuse of opioids. Available at https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm612779.htm. Accessed October 15, 2018.
How to Cite
Copyright 2005-2023, Weston Medical Publishing, LLC
All Rights Reserved