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Invasive lung cancer surgery may increase risk for long-term opioid use
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Patients with non-small cell lung cancer who underwent open resection surgery appeared more likely to become long-term opioid users than those who underwent video-assisted thoracoscopic surgery, according to a retrospective study of Medicare patients.
“We know that opioid dependency can develop after patients are prescribed opioids for medical reasons, however, there has been very little work done in the U.S. looking at opioid use after surgery, and how surgical invasiveness might play a role,” Emanuela Taioli, MD, PhD, director of the institute for translational epidemiology, and professor of population health science and policy and thoracic surgery at Icahn School of Medicine at Mount Sinai, told HemOnc Today.
It is standard of care to prescribe opioids at discharge for pain management after surgery, according to researchers.
Taioli and colleagues used data from the SEER-Medicare linked database to identify 3,900 patients with stage I primary NSCLC who underwent video-assisted thoracoscopic surgery, or VATS (n = 1,987, 50.9%) or open resection (n = 1,913, 49.1%) between 2007 and 2013.
Patients who were prescribed opioids within 30 days before surgery were excluded from the study.
Researchers defined long-term opioid use as having filled one or more prescriptions in the first 90 days following surgery and another prescription 90 to 180 days after surgery.
Overall, 70.9% of patients were discharged with an opioid prescription and 15.5% had a record of long-term postoperative use.
Patients who underwent VATS appeared more likely to be women and older; have a smaller tumor, adenocarcinoma, limited resection and a lower comorbidity score; belong to a higher income quartile; and live in an urban area. They were significantly less likely than those who underwent open resection to have filled an opioid prescription within 90 days after surgery.
After adjustment, patients appeared significantly less likely to use opioids long-term if they:
- underwent VATS (OR = 0.69; 95% CI, 0.57-0.84);
- were older (OR = 0.96; 95% CI 0.94-0.98); and
- had higher incomes (OR = 0.77; 95% CI 0.6-0.99).
Long-term opioid use appeared more likely among patients who had higher comorbidity scores (OR = 1.1; 95% CI, 1.05-1.16), large-cell histology (OR = 1.88; 95% CI, 1.17-3), used sleep medication 30 days before surgery (OR = 1.72; 95% CI, 1.28-2.32), and had previous psychiatric conditions (OR = 1.64; 95% CI, 1.28-2.09).
Results showed 15.5% of patients who were not previous opioid users became long-term opioid users after surgery.
The findings suggested surgical invasiveness may play a role in the risk for long-term opioid use after surgery, according to researchers.
“When weighing surgical options, surgical invasiveness and long-term opioid use should be considered. For lung cancer surgery, this is another reason why video-assisted thoracic surgery might be considered as an option instead of open surgery,” Taioli said. “Clinicians should ask their patients about their pain and opioid use at follow-up visits after surgery. If they choose to treat patients with opioids for the immediate postoperative acute pain, if pain persists they should consider switching to another pain management strategy as opioids should not be used for the treatment of chronic pain.”
The limitations of the study included the inability to determine if patients acquired opioids from friends or family members. – by Cassie Homer
For more information:
Emanuela Taioli, MD, PhD, can be reached at Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY 10029; email: emanuela.taioli@mountsinai.org.
Disclosures: The authors report no relevant financial disclosures.
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