Evaluating the incidence and predictors of chronic opioid use in early survivorship for patients with diffuse large...

Opioid exposure during cancer treatment is common and leads to new persistent opioid use (NPOU) in a subset of patients. There are limited data on the incidence and predictors of NPOU among patients with diffuse large B-cell lymphoma (DLBCL).

We conducted a population-based cohort study including patients with DLBCL ≥18 years old from Ontario, Canada who received first-line rituximab-based chemoimmunotherapy from 2014-2021 and survived >365 days after treatment. We defined opioid exposure as filling ≥1 opioid prescriptions between 90 days prior to and 180 days after first chemoimmunotherapy (index date). The primary outcome was NPOU defined as filling ≥1 opioid prescriptions within both 181-360 days and 361-545 days after index. We used a multivariable modified Poisson regression model to assess the relative risk (RR) of NPOU.

Our cohort consisted of 4,988 patients with DLBCL with a median age of 66 years. Opioid exposure occurred in 55.0% of patients. 6.7% of patients fulfilled criteria for NPOU, including 10.4% of exposed patients compared to 2.4% of unexposed patients. In the multivariable analysis, exposed patients were four times more likely to develop NPOU (RR 3.79, 95% CI 2.85-5.06). Other predictors of NPOU included relapsed/refractory disease, palliative care utilization, prior mental health diagnoses, and high-dose vs. low-dose opioid exposure.

>1 in 2 DLBCL patients were exposed to opioids during treatment and 1 in 10 exposed patients developed NPOU. Our study identified several predictors of NPOU in DLBCL, which may enable clinicians to identify high-risk patients who would benefit from early intervention.