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Improvement in patient-reported pain among patients with metastatic cancer and its association with opioid prescribing

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Abstract

Purpose

Opioids are a mainstay of cancer pain management; however, patients with metastatic cancer are often excluded from studies, leading to a lack of evidence on whether increased prescribing (dosage and/or duration) results in improved outcomes for this population. This study aimed to investigate whether increased opioid prescribing is associated with an improvement in patient-reported pain among patients with metastatic cancer.

Patients and methods

A retrospective cohort of all adult patients diagnosed with stage IV cancers, who completed at least two patient-reported outcomes (PROs) within 30 days of each other, was identified from administrative data. Opioid prescriptions were categorized by dosage level and number of prescription days. Multivariable logistic regression was used to investigate the association between opioid prescribing and clinically important improvement in pain score (≥ 1 point change on the Edmonton Symptom Assessment System).

Results

A total of 2169 patients were included, 770 (35.5%) of whom had active opioid prescription between PROs, with an average daily dosage of 86.1 mg of oral morphine equivalent. Active prescription was associated with improvement in pain (OR = 2.17, P < 0.001). However, among patients with active prescription, neither dosage nor number of prescription days was significantly associated with pain improvement.

Conclusion

Opioid prescription is important for treating cancer-related pain; however, increased dosage or duration may not be leading to greater improvements in pain. Patients with metastatic cancer who are receiving increased opioid prescribing may have difficult-to-treat pain and may benefit from multidisciplinary pain management strategies to supplement opioid prescription and improve outcomes.

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Data Availability

All data used for the analyses in this paper were abstracted from provincial administrative data sources in Alberta, Canada.

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Acknowledgements

All authors are affiliated with the University of Calgary and/or Alberta Health Services and are grateful to team members who were involved in the planning, design, and resources which made this study possible.

Author information

Authors and Affiliations

  1. Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada

    Hannah Harsanyi, Lin Yang, May Lynn Quan, Winson Y. Cheung, Sasha Lupichuk, Colleen Cuthbert & Yuan Xu

  2. Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada

    Lin Yang & Andrew Harper

  3. Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada

    Tamer N. Jarada, May Lynn Quan, Winson Y. Cheung, Sasha Lupichuk & Yuan Xu

  4. Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    May Lynn Quan & Yuan Xu

  5. Faculty of Nursing, University of Calgary, Calgary, AB, Canada

    Colleen Cuthbert

  6. The Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Yuan Xu

Authors
  1. Hannah Harsanyi
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Contributions

Conceptualization: Yuan Xu, Colleen Cuthbert, Lin Yang, Hannah Harsanyi, Sasha Lupichuk, May Lynn Quan, and Winson Cheung. Methodology: Yuan Xu, Colleen Cuthbert, Lin Yang, and Hannah Harsanyi. Data curation: Winson Cheung and Tamer Jarada. Formal analysis and investigation: Hannah Harsanyi, Andrew Harper, and Yuan Xu. Writing—original draft preparation: Hannah Harsanyi. Writing—review and editing: Hannah Harsanyi, Colleen Cuthbert, Lin Yang, Yuan Xu, Sasha Lupichuk, May Lynn Quan, and Winson Cheung. Funding acquisition: N/A. Resources: Yuan Xu. Supervision: Colleen Cuthbert, Lin Yang, and Yuan Xu.

Corresponding author

Correspondence to Hannah Harsanyi.

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Ethics approval

This study was approved by the Health Research Ethics Board of Alberta and was completed in accordance with ethical standards outlined in the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.

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Colleen Cuthbert and Yuan Xu contributed equally to this work.

Abstract previously accepted and presented at the Canadian Centre for Applied Research in Cancer Control (ARCC) Conference 2022.

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Harsanyi, H., Yang, L., Harper, A. et al. Improvement in patient-reported pain among patients with metastatic cancer and its association with opioid prescribing. Support Care Cancer 31, 427 (2023). https://doi.org/10.1007/s00520-023-07893-2

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