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Lu Z, Zhang N, Giordano SH, Zhao H. Opioid use and associated factors among pancreatic cancer patients diagnosed between 2007 and 2015. Cancer Med 2022; 11:2296-2307. [PMID: 35199472 PMCID: PMC9160802 DOI: 10.1002/cam4.4610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Opioid therapy provides essential pain relief for cancer patients. We used the population-based Surveillance Epidemiology and End Results (SEER) linked with Medicare database to identify the patterns of opioid use and associated factors in pancreatic adenocarcinoma cancer patients 66 years or older. PATIENTS AND METHODS We assessed opioid types, dispensed days, opioid uptake rates, and factors associated with opioid use after pancreatic adenocarcinoma cancer diagnosis in Medicare beneficiaries between 2007 and 2015 from the SEER-Medicare data. Multivariable regression analysis was used to adjust for a variety of patient-related factors. RESULTS We identified a cohort of 10,745 pancreatic cancer patients with a median age of 76 years old and median survival of 7 months; 75% of patients-initiated opioids after cancer diagnosis. African Americans had the lowest rate of opioid use of 69.1% compared with all other race/ethnicity groups at around 75%. No significant yearly trend of prescribing opioids was detected. Hydrocodone was the most frequently prescribed opioid type. Regression analysis revealed that age ≤80 years, residing in Southern or Western SEER registries, residing in urban/less urban versus big metro areas, having stage IV cancer at diagnosis, longer survival time, and undertaking cancer-directed treatment or using palliative care were positively associated with opioid initiation, more prescribed opioid types, and higher opioid doses. DISCUSSION While a range of sociodemographic variables were associated with opioid use in unadjusted analysis, the associations between race/ethnicity, gender, and socioeconomic status with opioid initiation disappeared when sociodemographic factors, tumor characteristics, and cancer treatment were adjusted. CONCLUSION Health care professionals' opioid prescription pattern for pancreatic cancer patients does not parallel the U.S. opioid epidemic. Racial/ethnic disparities in opioid treatment were not identified.
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Affiliation(s)
- Zhanni Lu
- Department of Palliative, Rehabilitation and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ning Zhang
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sharon H. Giordano
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hui Zhao
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Lo BD, Zhang GQ, Canner JK, Stem M, Taylor JP, Atallah C, Efron JE, Safar B. Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery. J Am Coll Surg 2022; 234:428-435. [PMID: 35290261 DOI: 10.1097/xcs.0000000000000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The worsening opioid epidemic has led to an increased number of surgical patients with chronic preoperative opioid use. However, the impact of opioids on perioperative outcomes has yet to be fully elucidated. The purpose of this study was to assess the association between preoperative opioid dose and surgical outcomes among colectomy patients. METHODS Adult colectomy patients in the IBM MarketScan database (2010-2017) were stratified based on preoperative opioid dose, calculated as the average opioid dose in morphine milligram equivalents (MME) in the 90 days prior to surgery: 0 MME, 1 to 49 MME, and 50 or more MME. The association between preoperative opioid dose and anastomotic leak, the primary outcome of interest, as well as other postoperative complications, was assessed using multivariable regression. RESULTS Among 45,515 adult colectomy patients, 71.4% did not use opioids (0 MME), 27.4% had an opioid dose between 1 and 49 MME, and 1.2% had an opioid dose at or above 50 MME. Patients with preoperative opioid use exhibited a higher incidence of anastomotic leak (0 MME: 4.8%, 1-49 MME: 5.5%, ≥50 MME: 8.3%; p trend = 0.001). Multivariable analysis demonstrated a dose-response relationship between preoperative opioids and surgical outcomes, as the odds of anastomotic leak worsened with increasing opioid dose (1-49 MME: OR 1.19, 95% CI 1.08-1.31, p < 0.001; ≥50 MME: OR 1.64, 95% CI 1.20-2.24, p = 0.002). Similar dose-response relationships were seen after risk-adjustment for lung complications, pneumonia, delirium, and 30-day readmission (p < 0.05 for all). CONCLUSIONS Providers should exercise caution when prescribing opioids preoperatively, as increasing doses of preoperative opioids were associated with worse surgical outcomes and higher 30-day readmission among adult colectomy patients.
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Affiliation(s)
- Brian D Lo
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - George Q Zhang
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Department of Surgery (Canner), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - James P Taylor
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chady Atallah
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan E Efron
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bashar Safar
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
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Schofield P, Dunham M, Martin D, Bellamy G, Francis SA, Sookhoo D, Bonacaro A, Hamid E, Chandler R, Abdulla A, Cumberbatch M, Knaggs R. Evidence-based clinical practice guidelines on the management of pain in older people – a summary report. Br J Pain 2020; 16:6-13. [PMID: 35111309 PMCID: PMC8801690 DOI: 10.1177/2049463720976155] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people. Design: Review of evidence since 2010 using a systematic and consensus approach is performed. Results: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines. Conclusion: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.
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Patel PM, Goodman LF, Knepel SA, Miller CC, Azimi A, Phillips G, Gustin JL, Hartman A. Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain. J Pain Symptom Manage 2017; 54:501-507. [PMID: 28729010 DOI: 10.1016/j.jpainsymman.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/29/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters. OBJECTIVES To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opioids during ED encounters based on home oral morphine equivalent (OME) use. METHODS We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a two-year period. The percentage of patients who received an adequate initial dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was evaluated. Logistic regression was used to establish the relationship between 24-hour ambulatory OME and initial ED OME to assess whether higher home usage was associated with higher likelihood of being undertreated. RESULTS Out of 216 patients, 61.1% of patients received an adequate initial PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home, 77.4% received an adequate initial dose; however, only 3.2% of patients taking >400 OMEs per day at home received an adequate dose. Patients with ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an adequate initial dose of PRN opioid in the ED compared to patients with ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00-0.02, P < 0.001). CONCLUSIONS Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.
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Affiliation(s)
- Pina M Patel
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Lauren F Goodman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
| | - Sheri A Knepel
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Charles C Miller
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Asma Azimi
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Gary Phillips
- The Ohio State University Center for Biostatistics, Columbus, Ohio, United States
| | - Jillian L Gustin
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Amber Hartman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States; Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Iwamoto M, Higashi T, Miura H, Kawaguchi T, Tanaka S, Yamashita I, Yoshimoto T, Yoshida S, Matoba M. Accuracy of using Diagnosis Procedure Combination administrative claims data for estimating the amount of opioid consumption among cancer patients in Japan. Jpn J Clin Oncol 2015; 45:1036-41. [DOI: 10.1093/jjco/hyv130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/03/2015] [Indexed: 11/13/2022] Open
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Gagnon B, Scott S, Nadeau L, Lawlor PG. Patterns of community-based opioid prescriptions in people dying of cancer. J Pain Symptom Manage 2015; 49:36-44.e1. [PMID: 24945491 DOI: 10.1016/j.jpainsymman.2014.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/09/2014] [Accepted: 05/28/2014] [Indexed: 11/21/2022]
Abstract
CONTEXT Studies of opioid use in cancer patients have been cross-sectional or have focused on mean consumption over a specific time interval. OBJECTIVES This study aimed to determine the temporal pattern of prescribed opioids at a population level. METHODS Using Quebec administrative databases, we ascertained details of cancer-related deaths and filled community-based opioid prescriptions (COPs) in 48,420 decedents from 2003 to 2006. RESULTS Using group-based trajectory modeling, based on when people started to fill COPs, our population-based study demonstrated patterns of filled COPs with six distinct trajectories. An earlier start in opioid consumption resulted in a higher group average morphine daily dose; those who were already filling COPs at study entry (5.2%) had a final dose of more than 300mg by the time of death. Remarkably, 58.8% of people had not filled COPs with a biweekly average greater than 1mg earlier than two weeks before death, marking the end of follow-up. Breast cancer in women, prostate or colorectal cancer in men, and younger age and multiple myeloma in both sexes were positively associated with earlier filling of COPs. CONCLUSION Patients dying of cancer require increasing doses of opioids over time; although we cannot distinguish the relative contributions of disease progression and opioid tolerance, age and certain cancers seem related to this phenomenon. Given the potentially prohibitive cost of prospective epidemiological studies, more elaborate clinical administrative databases that include regular pain assessment are necessary to determine optimal opioid use and factors associated with dose increases over time at a population level.
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Affiliation(s)
- Bruno Gagnon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Québec City, Québec, Canada.
| | - Susan Scott
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Québec, Canada
| | - Lyne Nadeau
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Québec, Canada
| | - Peter G Lawlor
- Division of Palliative Care, Departments of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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