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Cited by 19Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

Opioid use in cancer patients compared with noncancer pain patients in a veteran population

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Mudumbai, Seshadri C, He, Han, Chen, Ji-Qing, Kapoor, Aditi, Regala, Samantha, Mariano, Edward R, Stafford, Randall S, Abnet, Christian C +3 more·2024·JNCI Cancer Spectrum
DOI 10.1093/jncics/pkae012PMC PMC11009465
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Abstract

BACKGROUND: Opioid safety initiatives may secondarily impact opioid prescribing and pain outcomes for cancer care. METHODS: We reviewed electronic health record data at a tertiary Veterans Affairs system (VA Palo Alto) for all patients from 2015 to 2021. We collected outpatient Schedule II opioid prescriptions data and calculated morphine milligram equivalents (MMEs) using Centers for Disease Control and Prevention conversion formulas. To determine the clinical impact of changes in opioid prescription, we used the highest level of pain reported by each patient on the 0-to-10 Numeric Rating Scale in each year, categorized into mild (0-3), moderate (4-6), and severe (7 and above). RESULTS: Among 89 569 patients, 9073 had a cancer diagnosis. Cancer patients were almost twice as likely to have an opioid prescription compared with noncancer patients (69.0% vs 36.7%, respectively). The proportion of patients who received an opioid prescription decreased from 27.1% to 18.1% (trend P < .01) in cancer patients and from 17.0% to 10.2% in noncancer patients (trend P < .01). Cancer and noncancer patients had similar declines of MMEs per year between 2015 and 2019, but the decline was more rapid for cancer patients (1462.5 to 946.4, 35.3%) compared with noncancer patients (1315.6 to 927.7, 29.5%) from 2019 to 2021. During the study period, the proportion of noncancer patients who experienced severe pain was almost unchanged, whereas it increased among cancer patients, reaching a significantly higher rate than among noncancer patients in 2021 (31.9% vs 27.4%, P < .01). CONCLUSIONS: Our findings suggest potential unintended consequences for cancer care because of efforts to manage opioid-related risks.

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  1. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335-351.
  2. Shoemaker-Hunt SJ, Wyant BE. The Effect of Opioid Stewardship Interventions on Key Outcomes: A Systematic Downloaded from https://academic.oup.com/jncics/advance-article/doi/10.1093/jncics/pkae012/7624626 by guest on 09 March 2024 · DOI

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Authors
Mudumbai, S. C., He, H., Chen, J.-Q., Kapoor, A., Regala, S., Mariano, E. R., Stafford, R. S., Abnet, C. C., Pfeiffer, R. M., Freedman, N. D., & Etemadi, A.
Affiliations
  • VA Palo Alto Health Care System (US)
  • Stanford Medicine (US)
  • National Institutes of Health (US)
Corresponding author
Mudumbai, Seshadri C
ORCID
Venue
JNCI Cancer Spectrum
Publisher
Oxford University Press (OUP)
Published
2024-02-29
Volume
8
Issue
2
ISSN
2515-5091 (ISSN-L)
DOI
10.1093/jncics/pkae012
PMC
PMC11009465
OpenAlex
W4392613692
Cited by
19
References
46
Citations by year
2026: 7 · 2025: 8 · 2024: 4
FWCI
7.87
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • JNCI Cancer Spectrum (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (A2211-075-036-033419.0)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
opioid prescribing, cancer pain, veterans, Schedule II opioids, morphine milligram equivalents, pain intensity, non-cancer pain
MeSH terms
Analgesics, Opioid, Humans, Neoplasms, Pain, Practice Patterns, Physicians', Veterans

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