Amy J Davidoff1,2,3, Maureen E Canavan4, Shelli Feder5, Shiyi Wang6,4,7, Ella Sheinfeld8,9, Erin E Kent10,11, Jennifer Kapo7,12, Carolyn J Presley13. 1. Yale School of Public Health, New Haven, CT, USA. Amy.Davidoff@Yale.Edu. 2. Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA. Amy.Davidoff@Yale.Edu. 3. Yale Cancer Center, New Haven, CT, USA. Amy.Davidoff@Yale.Edu. 4. Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA. 5. Yale National Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA. 6. Yale School of Public Health, New Haven, CT, USA. 7. Yale Cancer Center, New Haven, CT, USA. 8. Yale Fox Fellowship, New Haven, CT, USA. 9. Tel Aviv University, Tel Aviv, Israel. 10. National Cancer Institute, Bethesda, MD, Fairfax, VA, USA. 11. ICF, Inc, Fairfax, VA, USA. 12. Yale School of Medicine, New Haven, CT, USA. 13. The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Abstract
CONTEXT: Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing. OBJECTIVES: To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer. METHODS: Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy. RESULTS: Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication. CONCLUSIONS: Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.
CONTEXT: Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing. OBJECTIVES: To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer. METHODS: Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy. RESULTS: Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication. CONCLUSIONS: Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.
Entities:
Keywords:
Cancer; Medicare health outcomes study; Medicare part D; Opioids; Pain interference; Pain treatment
Authors: Stacie B Dusetzina; Aaron N Winn; Gregory A Abel; Haiden A Huskamp; Nancy L Keating Journal: J Clin Oncol Date: 2013-12-23 Impact factor: 44.544
Authors: Adam J Olszewski; Stacie B Dusetzina; Charles B Eaton; Amy J Davidoff; Amal N Trivedi Journal: J Clin Oncol Date: 2017-05-25 Impact factor: 50.717