Lerro, Catherine C.

Abstract Background Opioid stewardship policies could adversely affect pain management for patients with cancer. Yet patients with cancer are also at risk for opioid‐related harms. This study sought to determine trends in opioid prescribing by clinical stratum and pain for patients with cancer from 2016 to 2020. Methods A retrospective study was conducted of opioid‐naive adults with newly diagnosed cancer from 2016 to 2020 ( N = 10,232) in a large Connecticut health system. Logistic regression was used to calculate changes in the predicted probability of opioid prescribing from 2016 to 2020. Two subpopulations were examined: patients treated surgically ( n = 4405) and patients with metastatic cancer ( n = 2158). Flowsheet pain scores for patients with metastatic cancer were used to stratify by no pain (all scores, 0) versus any pain. The main outcomes were new (≥1 prescription in the 0–6 months after diagnosis) and additional (0–6 and 7–9 months) opioid prescriptions. Results A decline was observed in the predicted probability of new (71.1% to 64.6%; p < .001) and additional prescribing (27.2% to 24.2%; p = .07 [not significant]) declined. Among surgical patients, the predicted probability of new opioid prescribing fell (96.0% to 88.6%; p < .001), whereas additional prescribing was stable (13%). For patients with metastatic cancer with pain, new opioid prescribing was stable (56%). For those reporting no pain, the predicted probability of new opioid prescribing declined from 61.6% to 36.1% ( p < .001). Conclusions In the context of widespread policy changes, this study showed a modest decline in new and additional opioid prescribing for patients with cancer. In metastatic cancer, prescribing remained stable for patients reporting pain and declined steeply for those reporting no pain.

11059 Background: Some opioid stewardship policies could negatively affect patients with cancer pain. However, patients with cancer are also at risk for opioid related harms, especially with persistent use. We assessed opioid prescribing trends in the context of cancer treatment and patient reported pain in a large health system in Connecticut. Methods: We conducted a retrospective cohort study of opioid-naïve adult patients with solid tumor malignancies diagnosed from 2016 through 2020 within the Yale New Haven Health System. We identified new (≥1 opioid prescription in 0-6 months following diagnosis) and additional (0-6 and 6-9 months) opioid prescriptions. The analysis evaluated all eligible patients as well as two clinical cohorts: patients treated surgically and patients with metastatic cancer. For patients with metastatic cancer and a documented pain score in the electronic health record flowsheet data, we further stratified by any (any score≥1) or no (all scores=0) pain in the 6 months since diagnosis and prior to first opioid, if given. For these patients, we noted therapeutic class of the first opioid. We used a logistic model adjusted for patient demographics to calculate predicted probability of opioid prescription and change over time. Results: A total of 10,868 patients met study criteria. Overall, we observed a decline in new opioid prescribing from 69.0% to 62.7% (p<.001) (Table). Additional opioid use also declined from 23.4% to 20.2% (p=.02). In the surgery cohort, new opioid prescribing fell from 95.7% to 88.2% (p<.001), while additional opioid use was stable over time (approximately 12%). For patients with metastatic cancer with any documented pain, new opioid prescribing was stable over time (approximately 56%). For those with documented pain scores=0, new opioid prescribing declined from 59.7% to 34.2% (p<.001). In these patients, the class listed on the first opioid prescription was analgesia in 86.6% and cough in 13.4%. Conclusions: Overall, and in patients treated with oncological surgeries, our study in a single large US health system suggests a modest, gradual decline in opioid prescribing for patients with cancer over time. On the other hand, among patients with metastatic cancer, opioid prescribing remained stable for those with documented pain and declined steeply for those without documented pain. [Table: see text]

Abstract Background The impact of ongoing efforts to decrease opioid use on patients with cancer remains undefined. Our objective was to determine trends in new and additional opioid use in patients with and without cancer. Methods This retrospective cohort study used data from Surveillance, Epidemiology, and End Results program–Medicare for opioid-naive patients with solid tumor malignancies diagnosed from 2012 through 2017 and a random sample of patients without cancer. We identified 238 470 eligible patients with cancer and further focused on 4 clinical strata: patients without cancer, patients with metastatic cancer, patients with nonmetastatic cancer treated with surgery alone (“surgery alone”), and patients with nonmetastatic cancer treated with surgery plus chemotherapy or radiation therapy (“surgery+”). We identified new, early additional, and long-term additional opioid use and calculated the change in predicted probability of these outcomes from 2012 to 2017. Results New opioid use was higher in patients with cancer (46.4%) than in those without (6.9%) (P &lt; .001). From 2012 to 2017, the predicted probability of new opioid use was more stable in the cancer strata (relative declines: 0.1% surgery alone; 2.4% surgery+; 8.8% metastatic cancer), than in the noncancer stratum (20.0%) (P &lt; .001 for each cancer to noncancer comparison). Early additional use declined among surgery patients (‒14.9% and ‒17.5% for surgery alone and surgery+, respectively) but was stable among patients with metastatic disease (‒2.8%, P = .50). Conclusions Opioid prescribing declined over time at a slower rate in patients with cancer than in patients without cancer. Our study suggests important but tempered effects of the changing opioid climate on patients with cancer.