Long‐Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Abstract

To examine the rates and predictors of long-term opioid therapy in older cancer survivors Retrospective cohort study. Texas, United States. Cancer survivors (≥ 5 years post-cancer diagnosis) diagnosed from 1995 to 2008 and who were also Medicare Part A, B, and D beneficiaries. We used Medicare Part D event data to calculate the proportion of cancer survivors with a prolonged opioid prescription (≥90-day supply of opioids/year). Adjusted odds ratios were calculated to identify predictors of prolonged opioid prescribing. All analyses were repeated with a sub-cohort of opioid naïve cancer survivors. The rate of prolonged opioid therapy for cancer patients diagnosed in 2008 was 7.1% prior to cancer diagnosis; it rose to 9.8% within a year of cancer treatments, and to 13.3% at five years post-diagnosis. The rate at the sixth year varied by cancer sites: 19.4% in lung cancer and 9.6% in prostate cancer. Among opioid naïve survivors, the rate increased from 1.4% to 7.1%, from five to eighteen years post-cancer diagnosis. Cancer survivors diagnosed in 2004–2008 had higher rates of opioid prescribing compared to those diagnosed in 1995–1998 and 1999–2003. Years since diagnosis, a later year of diagnosis, female gender, urban location, lung cancer diagnosis, disability as reason for Medicare entitlement, Medicaid eligibility, ≥1 comorbidity, and history of depression, drug abuse were predictors of prolonged opioid therapy. Among opioid naïve cancer survivors, diagnosis in 2004–2008 was the strongest predictor, while a history of drug abuse was the strongest predictor for all the survivors. The rates of prolonged opioid prescribing for older cancer survivors remained high at ≥ 5 years after cancer diagnosis. Our findings have potential to inform the development of clinical guidelines and public policy to ensure safer and more effective pain treatment in older cancer survivors.