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Impact of opioid use on health care utilization and survival in patients with newly diagnosed stage IV malignancies

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Abstract

Purpose

Patients with advanced cancers frequently experience pain. Opioids are commonly prescribed to treat cancer-related pain, but their use might be associated with undesirable consequences including adverse effects and tumor progression, resulting in increased heath care utilization and shorter survival. We examined these possibilities in a large cohort of patients diagnosed with ten common advanced malignancies.

Methods

We identified 1386 newly diagnosed patients with stage IV non-hematologic malignancies from 2005 to 2013 and ascertained opioid utilization within 90 days of starting anti-cancer treatment using electronic medical record and tumor registry data. Opioid utilization was stratified into low opioid (LO; < 5 mg oral morphine equivalents (OME)/day) and high opioid (HO; ≥ 5 mg OME/day). Health care utilization included tallies of emergency room, urgent care, and inpatient visits. The association of opioid use, tumor type prognosis, age, and gender with overall survival was analyzed in univariate and multivariate models.

Results

HO use patients (n = 624) had greater health care utilization compared to LO use patients (n = 762; p < 0.05). HO use patients also had shorter survival (median survival, 5.5 vs 12.4 months; p < 0.0001). On multivariate analysis, HO use remained associated with shorter overall survival (HR 1.4; 95% CI, 1.3–1.6; p < 0.0001) after adjusting for age, gender, and prognostic group.

Conclusions

In advanced cancer patients, HO use is associated with greater health care utilization and shorter survival. Prospective studies using opioid-sparing approaches are indicated, to confirm these retrospective findings and to evaluate if these undesirable effects associated with opioid use can be mitigated.

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Acknowledgments

The authors thank Arkadiusz Dudek, MD, PhD, and Jim Zacny for their critical review of this manuscript.

Funding

This study was supported by the Park Nicollet Foundation and HealthPartners Institute.

Author information

Authors and Affiliations

  1. Frauenshuh Cancer Center, Park Nicollet Oncology Research and HealthPartners Institute, 3800 Park Nicollet Blvd, Minneapolis, MN, 55416, USA

    Dylan Zylla, Grant Steele, Alice Shapiro & Sara Richter

  2. HealthPartners Institute, Minneapolis, MN, USA

    Dylan Zylla, Grant Steele & Alice Shapiro

  3. Professional Data Analysts, Inc., Minneapolis, MN, USA

    Sara Richter

  4. Hematology/Oncology Section, Department of Medicine, Minneapolis VA Health Care System, Minneapolis, USA

    Pankaj Gupta

Authors
  1. Dylan Zylla
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  2. Grant Steele
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  3. Alice Shapiro
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  4. Sara Richter
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  5. Pankaj Gupta
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Contributions

All authors have read and approved the manuscript.

Corresponding author

Correspondence to Dylan Zylla.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Data control

We have full control of all primary data and agree to allow the journal to review this data if requested.

Ethical statement

All institutional guidelines for the proper conduction of clinical research were followed for this study.

Appendix

Appendix

Table 4 Percentage and cancer type for each of 10 most common malignancies in the institutional Cancer Registry
Full size table
Table 5 Patient demographics for all patients (n = 1386), lung cancer (n = 535), or non-lung cancer (n = 851) patients and high opioid (HO) vs low opioid (LO) exposure during the first 3 months of treatment
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Zylla, D., Steele, G., Shapiro, A. et al. Impact of opioid use on health care utilization and survival in patients with newly diagnosed stage IV malignancies. Support Care Cancer 26, 2259–2266 (2018). https://doi.org/10.1007/s00520-018-4062-z

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  • DOI: https://doi.org/10.1007/s00520-018-4062-z

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