Lisa Barbera1, Rinku Sutradhar2, Anna Chu2, Hsien Seow3, Doris Howell4, Craig C Earle5, Mary Ann O'Brien6, Deb Dudgeon7, Clare Atzema8, Amna Husain9, Ying Liu2, Carlo DeAngelis10. 1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: lisa.barbera@sunnybrook.ca. 2. Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada. 3. Department of Oncology, McMaster University, Hamilton, Ontario, Canada. 4. University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada. 5. Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 6. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 7. Department of Medicine and Oncology, Queen's University, Kingston, Ontario, Canada. 8. Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 9. Mount Sinai Hospital, Temmy Latner Centre for Palliative Care, Toronto, Ontario, Canada. 10. Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Opioid prescribing has been increasingly scrutinized among noncancer patients. As an unintended consequence, opioids may be underprescribed for cancer patients. The purpose of this study was to compare trends in opioid prescribing in younger adults with and without cancer. METHODS: From 2004 to 2013, Ontario residents aged 18-64 years eligible for government paid pharmacare were annually stratified into three groups: no cancer history, cancer diagnosis more than five years ago, and cancer diagnosis five years ago and less. We evaluated time trends in two annual outcomes: opioid prescription rate and mean daily opioid dose. RESULTS: In 2013, 800,371 individuals were eligible for this study (3% with recent cancer and 2% with remote cancer). Across all years, compared with noncancer patients, overall opioid prescription rates were 43% and 26% higher for those with recent and remote cancer, respectively. Overall, a 1% relative annual increase was seen in those without cancer and a 1% decrease was seen in those with a recent cancer. Changes in prescription rates varied with drug class and cancer group. Notably, long-acting opioids had a relative annual increase of 7% in noncancer patients vs. 2% in recent cancer patients. Immediate-release combination agents had a relative annual decrease of 2% for all cancer groups. Trends in mean daily dose were similar between groups, but by 2013, they were lowest in recent cancer patients, regardless of drug class. INTERPRETATION: Secular trends in opioid prescribing affect cancer and noncancer patients similarly. Further research is required to assess the potential impact on symptom management.
BACKGROUND: Opioid prescribing has been increasingly scrutinized among noncancer patients. As an unintended consequence, opioids may be underprescribed for cancerpatients. The purpose of this study was to compare trends in opioid prescribing in younger adults with and without cancer. METHODS: From 2004 to 2013, Ontario residents aged 18-64 years eligible for government paid pharmacare were annually stratified into three groups: no cancer history, cancer diagnosis more than five years ago, and cancer diagnosis five years ago and less. We evaluated time trends in two annual outcomes: opioid prescription rate and mean daily opioid dose. RESULTS: In 2013, 800,371 individuals were eligible for this study (3% with recent cancer and 2% with remote cancer). Across all years, compared with noncancer patients, overall opioid prescription rates were 43% and 26% higher for those with recent and remote cancer, respectively. Overall, a 1% relative annual increase was seen in those without cancer and a 1% decrease was seen in those with a recent cancer. Changes in prescription rates varied with drug class and cancer group. Notably, long-acting opioids had a relative annual increase of 7% in noncancer patients vs. 2% in recent cancerpatients. Immediate-release combination agents had a relative annual decrease of 2% for all cancer groups. Trends in mean daily dose were similar between groups, but by 2013, they were lowest in recent cancerpatients, regardless of drug class. INTERPRETATION: Secular trends in opioid prescribing affect cancer and noncancer patients similarly. Further research is required to assess the potential impact on symptom management.
Authors: Amy J Davidoff; Maureen E Canavan; Shelli Feder; Shiyi Wang; Ella Sheinfeld; Erin E Kent; Jennifer Kapo; Carolyn J Presley Journal: Support Care Cancer Date: 2019-10-21 Impact factor: 3.603