Main Session
Sep
30
PQA 08 - Gastrointestinal Cancer, Nonmalignant Disease, Palliative Care
3514 - Opioid-Related Hospitalizations and Benzodiazepine Co-Prescription in Older Cancer Survivors
Presenter(s)
Sakshith Reddy Chintala, MS - University of California San Diego Health, San Diego, CA
P. Riviere1,2, S. R. Chintala3, K. M. Morgan4, L. Vitzthum5, J. D. Murphy6,7, and B. S. Rose8,9; 1University of Washington Department of Radiation Oncology, Seattle, WA, 2University of California San Diego Department of Radiation Medicine and Applied Sciences, La Jolla, CA, 3UCSD Department of Radiation Medicine and Applied Sciences, San Diego, CA, 4VA San Diego, San Diego, CA, 5Stanford University School of Medicine, Stanford, CA, 6Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, 7Center for Health Equity Education and Research, University of California, San Diego, La Jolla, CA, 8VA San Diego Health Care System, La Jolla, CA, 9Department of Radiation Medicine and Applied Sciences, UC San Diego Health, San Diego, CA
Purpose/Objective(s):
Opioid analgesics are commonly prescribed at the time of curative-intent cancer therapies. These drugs are associated with a range of possible side effects which could result in unplanned ER visits or hospitalizations (termed “events”) and potentially delay or interrupt adjuvant therapies. This study hypothesized that the acute use of opioid analgesics would be associated with a minimal or non-significant increase in these events when taken in context of the baseline elevated risk of unplanned hospitalizations in older patients undergoing curative-intent surgery or radiation for a new cancer diagnosis.Materials/Methods:
This study used data from the Surveillance, Epidemiology and End Results Medicare-linked database to identify patients aged =65 diagnosed between 2010-2017 with bladder, breast, colon/rectum, head/neck, kidney, lung, or prostate cancer. Patients had to have non-metastatic disease, undergo a curative-intent local therapy, and have a minimum of 6 months of follow up following completion of local therapy. The primary event was hospitalization or emergency department visit for impaired colonic motility, acute mental health crisis, nausea or vomiting, delirium, overdose, opioid use disorder, and falls or fractures within six months of definitive intent surgery or radiation therapy. The primary exposure was opioid prescription in the month prior to treatment initiation through two months afterwards.Results:
We identified 299,370 patients, among whom 126,826 (42%) and 18,622 (6%) were prescribed an opioid or a benzodiazepine at time of cancer treatment, respectively. Opioids were prescribed for a median of 9 days (interquartile range 5-33). Among the patients who were prescribed an opioid, over the three-month exposure period the median daily OME was 3.3 mg (interquartile range 1.7-10.6). Overall, 27% of patients experienced an event. There were 106,065 events of which 5,684 (5.6%) were specifically from opioid use disorder or drug overdose. Opioid prescription was associated with odds ratio (OR) of an event of 1.13 (1.11-1.15, p < 0.001) as compared to the benzodiazepine prescription OR 2.45 (95% CI 2.29-2.61, p < 0.001); there was no significant interaction between these prescriptions. In multivariable analysis, other specific risk factors for events with large effect sizes included diagnosis of high-risk psychiatric disorders (OR of 7.46 95% CI 7.14-7.79), diagnosis of colorectal cancer (OR of 2.30 95% CI 2.23-2.37, p < 0.001 as compared to prostate cancer), and Charlson Comorbidity Index of =2 (OR 2.01 95% CI 1.97-2.05).Conclusion:
Opioid prescription during cancer treatment is associated with a modest increase in unplanned associated hospitalizations and emergency department visits. These events are common at baseline in the absence of opioid prescriptions. Physicians should be mindful of co-prescribed benzodiazepines as well as pre-existing psychiatric and medical comorbid conditions that have a greater association with these serious events.