1017 - Federal Opioid Prescribing Guidelines and Pain among Individuals with and without a Cancer History

Purpose/Objective(s): Cancer-associated pain is common among survivors and may require opioid medications for effective management. In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines to limit opioid prescribing, leading to a subsequent decline in prescriptions in the US. While cancer-associated pain is explicitly exempted by the CDC guidelines, it is unknown whether prescribing patterns have impacted cancer survivors. Our objective was to determine whether there were differences in pain control between individuals with and without (w/o) a cancer history, and within certain demographic groups.

Materials/Methods: Data were obtained from the 2011-2023 Behavioral Risk Factor Surveillance System (BRFSS), an annual, national survey. The primary endpoint was freedom from quality of life (QoL)-limiting pain (FFQLP; limited to 2011-17), defined as having zero days in the past month where pain interfered with usual activities. Secondary endpoint was cancer-associated pain (limited to 2016-23). Difference-in-differences (DID) analyses compared changes in FFQLP from pre- to post-2016 guidelines between individuals with and w/o a cancer history. Trends in cancer-associated pain after 2016 were also assessed among cancer survivors. Models adjusted for year-quarter fixed effects and sociodemographic factors. Analyses accounted for the complex survey design and weights of the BRFSS.

Results: 2,725 cancer survivors and 25,104 individuals w/o a cancer history were included in the FFQLP analyses. FFQLP remained stable from pre- (73.6%) to post-2016 (76.7%) among individuals w/o a cancer history and increased slightly among survivors (56.0% to 65.4%); these trends were not significantly different in DID analyses (P=.13). In subgroup DID analyses, there were relative improvements in FFQLP for various subgroups of survivors post-2016: ages 18-39 years (34.36 percentage points [95% CI = 11.25 to 57.48], P=.004), non-Hispanic Black (19.24 [-0.10 to 38.59], P=.051), higher household income (11.72 [1.19 to 22.25], P=.029), and college education (8.31 [0.14 to 16.48], P=.046). There were no significant changes in cancer-associated pain after 2016.

Conclusion: Cancer survivors have higher pain burdens than those without a cancer history, with QoL limiting pain affecting at least a third. Publicized 2016 national opioid guidelines with explicit survivorship carveouts did not appear to change pain control for survivors overall, however certain groups including young adult and Black cancer survivors may be benefited. These populations have historically faced access to care barriers for adequate pain management. Given differential benefit seen for survivors of higher socioeconomic status however, it appears that cancer exemptions to opioid prescribing laws may not provide adequate protections for other socioeconomically disadvantaged subgroups of cancer survivors.