Prescribing Patterns of Opiate Use Among Patients with Cancer

Although few statistics are available to assess how patients with cancer are affected by prescription opioid use, a recent study found that 70% of patients with cancer use opiates after radiation, according to a poster presented at the ASCO 2018 Palliative and Supportive Care in Oncology Symposium.¹

Moreover, the researchers found higher rates of use among patients who received chemotherapy, actively smoked, used alcohol, or were diagnosed with head and neck cancer, while cancer survivors who were treated with radiation for more than 4 weeks had high rates of opiate use 1 year after finishing treatment.

Opioids are commonly prescribed for the management of moderate to severe chronic pain experienced by patients undergoing treatment for cancer, yet according to ESMO clinical practice guidelines published in the Annals of Oncology, cancer pain is still undertreated.² Scott Gottlieb, MD, Commissioner of the Food and Drug Administration (FDA) acknowledged that the FDA faces a difficult task in “striking the right balance between reducing the rate of new addiction while providing appropriate access to those who need these medicines.”³

“We don’t know how many cancer patients died from prescription opiates and there is little published data about their prescribing patterns,” wrote the researchers, from the University of Texas Southwestern Medical Center (UTSW) in Dallas.

To add to the body of knowledge around opioid use in patients with cancer, the researchers studied data from 6424 patients with lung, breast, and head and neck cancer recorded in the UTSW tumor registry from 2009-2016. They analyzed prescription data for these patients, who were undergoing therapy including radiation. They assessed demographics, cancer type, treatment modality, concurrent medicines, substance abuse history, and survival.

The researchers saw widespread use among genders, with 76% of 2112 men and 67% of 4307 women who reported to use these medications, of which 8% had 3 or more different opiates prescribed. Hydrocodone was the most commonly used (67%), followed by morphine (12%), fentanyl (9%), oxycodone (7%), and hydromorphone (6%).

In total, 18.7% of women and 15.9% of men received gabapentin. A neuropathic pain reliever, gabapentin is commonly prescribed to those addicted or at risk of addiction to opioids. Lately, gabapentin has increasingly been found in people who have overdosed on heroine or prescription opioids,⁴ so although it is not an opioid, scrutiny of its use is growing.

Of the 850 patients who received chemotherapy and radiation, 696 required opiates (82%) compared to 68% of those who did not receive chemotherapy (3807/5574; P <.0001). Patients with head and neck cancer reported the highest rate of opioid abuse (77%) compared with those with breast (65%) or lung cancer (70%).

Lastly, the researchers found that of the 2643 patients who used alcohol, 2001 received opiates (76%) compared to 67% of those who did not use alcohol (n = 3145; P <.0001). Among active smokers (n = 1366), 76% used opiates versus 67% of those who never smoked (n = 2815; P <.0001).

References

• Westbrook KA, Ahn C, Khan SA. Prevalence and usage patterns of opiates in patients with lung, breast, and head and neck cancer. Presented at: the ASCO 2018 Palliative and Supportive Care in Oncology Symposium, November 16-18, 2018; San Diego, Calif. J Clin Oncol. 2018;36(suppl 34). Abstract 120. meetinglibrary.asco.org/record/167120/abstract. Accessed November 18, 2018.
• Fallon M, Giusti R, Aielli F, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29(suppl 4):iv166—iv191. doi: 10.1093/annonc/mdy15 esmo.org/Guidelines/Supportive-and-Palliative-Care/Management-of-Cancer-Pain-in-Adult-Patients. Accessed November 18, 2018.
• Gottlieb S. Addressing needs of patients while stemming the tide of the opioid crisis. FDA website. fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm612779.htm. May 14, 2018. Accessed November 18, 2018.
• Vestal C. Abuse of opioid alternative gabapentin is on the rise. Pew Charitable Trusts website. pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/05/10/abuse-of-opioid-alternative-gabapentin-is-on-the-rise. Published May 10, 2018. Accessed November 18, 2018.