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Recognizing the Risks: Opioid Use Among Cancer Patients

Andrew Robers, PharmD, PhD

September 21, 2020

Opioids for pain relief are often a necessity for cancer patients, but opioid use comes with its own set of risks. Two papers published by researchers at The University of Kansas Cancer Center bring those risks to light.

According to Andrew Roberts, PharmD, PhD, member of the cancer center’s Cancer Prevention and Control research program, the dangers of opioid use don’t just include overdose but other complications like falls and gastrointestinal problems, which older adults are predisposed to. Given that approximately 2 out of 3 cancer survivors are older adults, it is important to understand the unique risks this population faces.

“Older adults are generally at greater risk of experiencing a wider range of opioid safety concerns,” Dr. Roberts said. “Opioid use among cancer patients has been largely understudied, and we want to understand how the broader opioid crisis intersects with those dealing with cancer-related pain.”

Utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)-Medicare database, Dr. Roberts and his team conducted two retrospective studies. The first study, published in JAMA Network Open, analyzed 38,300 breast cancer patients aged 66 to 90 and assessed the risks of serious adverse events associated with continued prescription opioid use after completing active treatment for breast cancer. The team discovered that women who continued using opioids after breast cancer treatment had a nearly 15-fold increase in risk of opioid overdose, with 2 to 3-times higher risk of other opioid complications, like falls. Notably, these other opioid-related complications were over 20-times more common than overdose.

The second study, published in the Journal of the National Cancer Institute (JNCI), looked at nearly 70,000 individuals diagnosed with breast, colorectal or prostate cancer. The team estimated the odds of opioid use disorder and overdose following these common cancer diagnoses and found that while overdose was rare, the odds of opioid overdose more than doubled after a colorectal cancer diagnosis.

“Objectively, opioid overdoses in this group is still very unlikely,” Dr. Roberts said. “Still, these two studies establish that we should pay more attention to this population and recognize there may be opportunities to reduce their risk of adverse events related to opioid use.”

Opioids remain an important component of managing cancer pain, Dr. Roberts added. However, clinicians and patients should be mindful that opioid-related risks apply to everyone, including cancer patients. Adhering to guideline-recommended opioid prescribing practices for cancer pain and diligent monitoring of patients on opioid therapy is crucial for keeping patients safe. Next, Dr. Roberts intends to develop tools to help clinicians and cancer patients and survivors prevent avoidable opioid-related harms when such therapy is indicated.

“We are interested in those who transition into long-term survivorship with persistent opioid use,” Dr. Roberts said. “How many of them are still using opioids post-treatment, and are they good candidates to try other pain treatment options that carry fewer risks? There may be an opportunity to help older adult cancer survivors achieve effective pain control and a high quality of life without unnecessarily exposing them to the potential risks of opioid therapy.”

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