In a new study, researchers found how cancer survivors could develop opioid addictions.
The research was done by a team at the University of California San Diego and elsewhere.
Opioids play an important role in how cancer patients manage pain, but the ongoing opioid epidemic has raised concerns about their potential for abuse.
Pain remains one of the most difficult symptoms associated with cancer. More than half of cancer patients undergoing treatment experience moderate to severe pain.
Despite the accepted role of opioids in acute pain relief, the use of opioids for chronic pain (pain lasting longer three to six months) remains controversial.
Chronic opioid use can lead to diminishing effectiveness as well as dependence, misuse, abuse, and unintentional overdosing.
With an estimated 16.9 million cancer survivors in the United States and two-thirds of newly diagnosed cancer patients living more than five years, many cancer researchers believe it’s important to better understand opioid use in oncology patients.
While there are guidelines for how to help cancer patients avoid opioid dependence, many researchers are concerned that recommendations for risk reduction are based on expert opinion not related to cancer patients specifically.
In the study, the team examined 106,732 cancer survivors diagnosed between 2000 and 2015, and determined rates of persistent post-treatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity.
This study included patients diagnosed with one of the 12 most common cancers (bladder, breast, colon, esophagus, stomach, head and neck, kidney, liver, lung, pancreas, prostate, or rectal cancer), and alive without recurrence two years after treatment.
The team found that in the patients the overall incidence of persistent post-treatment opioid use was 8.3% which varied by cancer type ranging from a low of 5.3% in prostate cancer patients to a high of 19.8% in liver cancer patients.
Bladder, breast, esophagus, stomach, head and neck, liver, lung and pancreas cancer were associated with higher odds compared to prostate cancer.
The rates of persistent opioid use after treatment varied substantially by a patient’s history of opioid use prior to his receiving a cancer diagnosis.
The persistent post-treatment opioid use rates were lowest for patients who had never used opioids prior to their cancer diagnosis (3.5%) followed by prior intermittent users (15.0%), and prior chronic users (72.2%).
The rate of post-treatment diagnoses of opioid abuse or dependence was 2.9%, and opioid-related admissions occurred in 2.1% of patients.
The results showed that several factors were linked to the risk of persistent opioid use. Younger age, white race, unemployment at the time of cancer diagnosis, lower median income, increased comorbidity, and current or prior tobacco use were all linked to increased risk for persistent opioid use.
In addition, prior diagnoses of alcohol abuse, non-opioid drug abuse, opioid abuse, and depression were linked to increased odds.
Prior history of chronic opioid use and prior intermittent use were linked to substantially increased odds of persistent opioid use.
The team says clinical tools such as ours could help providers identify which patients could benefit from alternative pain management strategies or referral to pain specialists.
One author of the study is Lucas K. Vitzthum.
The study is published in the Journal of the National Cancer Institute.
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