Characterizing Pain and Opioid-Related Risks in Individuals With Advanced Cancer: A Cohort Study

Patients with advanced cancer are living longer, which can impact pain trajectories and management approaches. Opioids are commonly used to treat pain in these patients, yet there is limited data on current opioid management in this population.

We present baseline data from a prospective cohort study of patients with newly diagnosed advanced cancer.

Participants with a confirmed new diagnosis of advanced cancer and no history of long-term opioid use were recruited from five US oncology programs. Demographic information and validated patient-reported measures for pain (PEG score), comorbidities, and substance use measures were collected. We conducted descriptive statistics and assessed differences in PEG by short-duration opioid use with the Wilcoxon Rank Sum test.

Of the 490 participants in the baseline analysis, median age was 67 years. Most participants identified as male (56%) and White (79%); digestive cancer was most common (35%). Most participants (58%) reported at least one non-cancer comorbidity. Approximately, 30% reported no pain, 36% reported mild pain, 22% reported moderate pain, and 12% reported severe pain. The PEG score was higher (P < 0.001) in those who used opioids in the past 3 months. Approximately, one-third (38%) of individuals reported recent short-term prescription opioid use. High-risk substance use was reported for alcohol (62% lifetime and 9% within the past 3 months) and, to a lesser extent, tobacco and cannabis.

Older age, comorbidities, and substance use patterns noted in this population can impact pain trajectories and opioid safety.