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Temporal Trends in Opioid Use and Associated Outcomes for Patients Living with Advanced Cancer
Vikram Jairam1, Meghan E Lindsay2, Pamela R Soulos2
1Department of Radiation Oncology (V.J.), Sutter Medical Group, Sacramento, California; Cancer Outcomes (V.J., M.E.L., P.R.S., C.P.G., E.H.P., L.V.M.B., H.S.P.), Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut.
Journal of Pain and Symptom Management
|May 22, 2025
Summary
Regulatory changes decreased opioid prescribing, but advanced cancer patients saw more pain ED visits and opioid encounters, alongside increased gabapentinoid use. This highlights challenges in pain management post-opioid reduction.
Area of Science:
- Oncology
- Pain Management
- Public Health Policy
Background:
- Opioid prescribing has decreased due to regulatory actions addressing the opioid epidemic.
- The impact on non-opioid pain medication use, pain control, and high-risk opioid use in cancer patients remains unclear.
Purpose of the Study:
- To examine trends in opioid use, gabapentinoid use, emergency department (ED) visits for pain, and opioid-related encounters.
- To compare these trends in patients with and without advanced cancer.
Main Methods:
- Utilized the SEER-Medicare database (2012-2017) for patients aged 66+ with or without advanced solid tumors.
- Assessed opioid use, gabapentinoid use, pain-related ED visits, and opioid encounters within 12 months post-diagnosis.
- Employed multivariable logistic regression to analyze temporal changes in outcomes for both patient groups.
Main Results:
- Opioid use declined in both cancer (66.0% to 63.5%) and non-cancer (33.2% to 29.4%) cohorts.
- Gabapentinoid use significantly increased in both cancer (9.6% to 15.0%) and non-cancer (9.0% to 13.5%) groups.
- Patients with advanced cancer experienced a greater rise in pain-related ED visits (22.3% to 29.2%) and opioid-related encounters (0.7% to 4.2%) compared to non-cancer patients.
Conclusions:
- Decreased opioid prescribing may be linked to increased pain-related ED visits and opioid encounters in advanced cancer patients.
- Gabapentinoid use increased as a potential substitute for opioids, but did not fully mitigate adverse pain-related outcomes.
- Effective pain management strategies are crucial for cancer patients navigating reduced opioid availability.
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