Temporal Trends in Opioid Use and Associated Outcomes for Patients Living with Advanced Cancer.

Abstract

Regulatory efforts in response to the opioid epidemic have resulted in a decrease in opioid prescribing, but their impact on utilization of nonopioid pain medications, pain control, and high-risk opioid use is unknown in patients with and without advanced cancer. To investigate time trends in opioid use, along with potential associated effects such as gabapentinoid use, pain-related ED visits, and opioid-related encounters, in cancer and non-cancer patients. We queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from January 01, 2012 to December 31, 2017 to identify patients aged 66 years or older diagnosed with or without advanced solid tumor cancer. The four dependent outcomes assessed were opioid use, gabapentinoid use, pain-related ED visits, and opioid-related encounters within 12 months after the patient's diagnosis or index date. We used multivariable logistic regression models to calculate the predicted probability and temporal change of each outcome for patients with and without cancer. A total of 294,113 patients were included in the cohort; 45,899 (15.6%) with advanced cancer and 248,214 (84.4%) without cancer. Over the study period, the predicted probability of opioid use declined from 66.0% to 63.5% in the cancer cohort, and from 33.2% to 29.4% in the noncancer cohort, while gabapentinoid use increased in the cancer [9.6%-15.0%] and noncancer [9.0%-13.5%] cohorts (P < 0.01). There was a greater increase in pain-related ED visits [22.3%-29.2%] and opioid-related encounters [0.7%-4.2%] in patients with cancer than among noncancer patients (P < 0.001). Our findings showed a greater increase in pain-related ED visits and opioid -related encounters among patients with advanced cancer, potentially related to decreases in opioid prescribing, despite a compensatory increase in gabapentinoid use.