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Opioid deaths significantly less common among individuals with cancer
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Individuals with cancer appeared 10 times less likely than the general population to die as a result of opioid use, according to retrospective study results presented at ASCO Quality Care Symposium.
“Patients with cancer often rely on opioids to help manage their pain during treatment and to live comfortably with the disease,” study author Fumiko Chino, MD, radiation oncologist at Duke Cancer Institute, said in a press release.
“Without adequate pain management, patients can be forced to take breaks from lifesaving therapy or become hospitalized due to the side effects of treatment,” Chino added. “This study should provide both oncologists and patients with some reassurance that opioids can be a safe and effective option for managing cancer-related pain.”
More than 40,000 Americans died of opioid overdose in 2016. In October 2017, the federal government declared the opioid crisis a national public health emergency.
Although opioids often are prescribed for cancer-associated pain, the risks associated with opioid use in this setting had not been established.
Chino and colleagues obtained de-identified death certificate data from the National Center for Health Statistics. The death certificates specified one underlying cause of death and up to 20 contributing causes, as well as demographic data.
Researchers analyzed data for all deaths from 2006 to 2016 for which opioids were listed as the primary cause. Individuals for whom cancer was not listed as a contributing cause of death were included in the general population analysis.
Chino and colleagues reported 895 deaths due to opioids among patients with cancer and 193,500 deaths due to opioids among those who did not have cancer.
The number of opioid deaths in the general population increased during the study period from 5.33 per 100,000 people to 8.97 per 100,000 people (P < .001; polynomial fit, R2 = 0.99). The number of opioid deaths among the cancer population increased from 0.52 per 100,000 people to 0.66 per 100,000 people (P < .001; linear fit, R2 = 0.24; slope = 0.018).
“There was a slight increase in opioid deaths [among patients with cancer]; however, overall, there was not the sharp growth seen in the general population,” Chino and colleagues wrote.
When researchers analyzed demographics of individuals who died due to opioid use, they determined those who had cancer (median age, 57 years; interquartile range [IQR], 50-65) were older than those in the general population (median age, 42 years; IQR, 31-51).
Among all individuals who died due to opioid use, those who had cancer were more likely than those in the general population to be female (38.5% vs. 29.2%; P < .001), be non-Hispanic (94.5% vs. 91.3%; P = .027) and have obtained a college degree (12.7% vs. 6.9%; P < .001). Those in the general population were significantly more likely than those in the cancer population to be white (84.2% vs. 82.3%; P = .027) and be single (48.1% vs. 24.2%; P < .001).
Chino and colleagues also analyzed the underlying malignancies of those with cancer who died due to opioid use. They determined the most common malignancy in this group was lung cancer (22%), followed by gastrointestinal cancer (21%), head and neck cancer (12%), hematologic malignancies (11%) and genitourinary cancer (10%).
Chino and colleagues noted their study could be limited by incomplete cause-of-death reporting on death certificates, creating the possibility that the actual number of opioid-related deaths is higher than it appears.
Additional research should examine how regulations designed to address the opioid epidemic are affecting opioid access for patients with cancer, as well as the ability physicians have to prescribe these agents for management of cancer-related pain, Chino and colleagues wrote.
“[Patients with cancer] at risk for opioid overdose are different than those at risk in the general population,” they concluded. “Care should be taken when planning effective treatment of cancer-related pain.” – by Mark Leiser
Reference:
Chino FL, et al. Abstract 230. Presented at: ASCO Quality Care Symposium; Sept. 28-29, 2018; Phoenix.
Disclosure: Chino reports research funding from Varian Medical Systems, as well as stock or other ownership interests in Nanoscint. Please see the abstract for all other authors’ relevant financial disclosures.