Opioid Use in Patients With Testicular Cancer: Patterns and Risk Factors.

Area of Science:

• Oncology
• Urology
• Pain Management

Background:

• Prescription opioid use can lead to chronic dependence, morbidity, and mortality.
• Men undergoing urologic surgery have an increased risk of persistent opioid use.
• Factors driving persistent opioid use in testicular cancer patients are not well understood.

Purpose of the Study:

• To identify factors associated with persistent opioid use after orchiectomy in testicular cancer patients.
• To investigate the impact of advanced treatments on long-term opioid requirements.

Main Methods:

• Utilized the Truven Marketscan database (2009-2021) for testicular cancer patients undergoing orchiectomy.
• Excluded patients with prior opioid use or disorder, and those under 18 or lacking insurance.
• Defined opioid exposure based on prescription fills within 30 days of treatment, including pretreatment use for advanced therapy patients.
• Employed multivariable logistic regression to analyze risk factors for opioid prescriptions 31-180 days post-treatment.

Main Results:

• Opioid exposure within 30 days of treatment significantly correlated with subsequent opioid prescriptions (31-90 and 91-180 days post-treatment).
• Advanced treatments, specifically chemotherapy (alone or with RPLND), were independently associated with increased opioid use 31-180 days post-treatment.
• Retroperitoneal lymph node dissection (RPLND) alone did not show a significant association with persistent opioid use.

Conclusions:

• Testicular cancer patients receiving initial opioid prescriptions post-orchiectomy are at higher risk for continued use.
• Chemotherapy, with or without RPLND, is a significant risk factor for prolonged opioid dependence in this cohort.
• RPLND alone does not appear to elevate the risk of persistent opioid use after orchiectomy.