Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Supportive Care in Cancer
Published in: Supportive Care in Cancer 12/2020

01-12-2020 | Hemorrhoidectomy | Original Article

Cancer survivorship and its association with perioperative opioid use for minor non-cancer surgery

Authors: Samantha Eiffert, Andrea L. Nicol, Edward F. Ellerbeck, Joanna Veazey Brooks, Andrew W. Roberts

Published in: Supportive Care in Cancer | Issue 12/2020

Login to get access

Abstract

Purpose

Reducing high-risk prescription opioid use after surgery has become a key strategy in mitigating the opioid crisis. Yet, despite their vulnerabilities, we know little about how cancer survivors use opioids for non-cancer perioperative pain compared to those with no history of cancer. The purpose was to examine the association of cancer survivorship with the likelihood of receiving perioperative opioid therapy for non-cancer minor surgery.

Methods

Using 2007–2014 SEER-Medicare data for breast, colorectal, prostate, and non-cancer populations, we conducted retrospective cohort study of opioid-naïve Medicare beneficiaries who underwent one of six common minor non-cancer surgeries. Modified Poisson regression estimated the relative risk of receiving a perioperative opioid prescription associated with cancer survivorship compared to no history of cancer. Stabilized inverse probability of treatment weights were used to balance measurable covariates between cohorts.

Results

We included 1486 opioid-naïve older adult cancer survivors and 3682 opioid-naïve non-cancer controls. Cancer survivorship was associated with a 5% lower risk of receiving a perioperative opioid prescription (95% confidence interval: 0.89, 1.00; p = 0.06) compared to no history of cancer. Cancer survivorship was not associated with the extent of perioperative opioid exposure.

Conclusion

Cancer survivors were slightly less likely to receive opioid therapy for non-cancer perioperative pain than those without a history of cancer. It is unclear if this reflects a reduced risk of opioid-related harms for cancer survivors or avoidance of appropriate perioperative pain therapy. Further examination of cancer survivors’ experiences with and attitudes about opioids may inform improvements to non-cancer pain management for cancer survivors.
Appendix
Available only for authorised users
Literature
1.
Brummett CM, Waljee JF, Goesling J et al (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152(6):e170504CrossRef
2.
Lee JS, Hu HM, Edelman AL et al (2017) New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol Off J Am Soc Clin Oncol 35(36):4042–4049CrossRef
3.
Saraswathula A, Chen MM, Mudumbai SC, Whittemore AS, Divi V (2018) Persistent postoperative opioid use in older head and neck cancer patients. Otolaryngol Head Neck Surg :194599818778276
4.
Dewan KC, Dewan KS, Idrees JJ, et al. (2018) Trends and outcomes of cardiovascular surgery in patients with opioid use disorders. JAMA Surg
5.
Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM (2018) Persistent opioid use after wisdom tooth extraction. JAMA 320(5):504–506CrossRef
6.
Olds C, Spataro E, Li K, Kandathil C, Most SP (2019) Assessment of persistent and prolonged postoperative opioid use among patients undergoing plastic and reconstructive surgery. JAMA Facial Plast Surg
7.
Hanson KT, Thiels CA, Polites SF et al (2018) The opioid epidemic in acute care surgery-characteristics of overprescribing following laparoscopic cholecystectomy. J Trauma Acute Care Surg 85(1):62–70CrossRef
8.
Hill MV, McMahon ML, Stucke RS, Barth RJ Jr (2017) Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg 265(4):709–714CrossRef
9.
Nobel TB, Zaveri S, Khetan P, Divino CM (2019) Temporal trends in opioid prescribing for common general surgical procedures in the opioid crisis era. Am J Surg 217(4):613–617CrossRef
10.
Thiels CA, Anderson SS, Ubl DS et al (2017) Wide variation and overprescription of opioids after elective surgery. Ann Surg 266(4):564–573CrossRef
11.
Miller KD, Siegel RL, Lin CC et al (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66(4):271–289CrossRef
12.
Noone A, Howlader N, Krapcho M, et al. (2018) SEER Cancer statistics review, 1975–2015. National Cancer Institute
13.
Edlund MJ, Martin BC, Fan MY, Devries A, Braden JB, Sullivan MD (2010) Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study. Drug Alcohol Depend 112(1–2):90–98CrossRef
14.
Hoffman KE, McCarthy EP, Recklitis CJ, Ng AK (2009) Psychological distress in long-term survivors of adult-onset cancer: results from a national survey. Arch Intern Med 169(14):1274–1281CrossRef
15.
Jones SM, LaCroix AZ, Li W et al (2015) Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative. J Cancer Surviv 9(4):620–629CrossRef
16.
Manchikanti L, Giordano J, Boswell MV, Fellows B, Manchukonda R, Pampati V (2007) Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. J Opioid Manag 3(2):89–100CrossRef
17.
Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P (2013) Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol 14(8):721–732CrossRef
18.
Rice JB, White AG, Birnbaum HG, Schiller M, Brown DA, Roland CL (2012) A model to identify patients at risk for prescription opioid abuse, dependence, and misuse. Pain Med 13(9):1162–1173CrossRef
19.
Zhao G, Okoro CA, Li J, White A, Dhingra S, Li C (2014) Current depression among adult cancer survivors: findings from the 2010 behavioral risk factor surveillance system. Cancer Epidemiol 38(6):757–764CrossRef
20.
Lee JS, Hu HM, Edelman AL, et al. (2017) New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol Off J Am Soc Clin Oncol. Jco2017741363
21.
Sutradhar R, Lokku A, Barbera L (2017) Cancer survivorship and opioid prescribing rates: a population-based matched cohort study among individuals with and without a history of cancer. Cancer
22.
23.
Koepke EJ, Manning EL, Miller TE, Ganesh A, Williams DGA, Manning MW (2018) The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioper Med (Lond) 7:16–16CrossRef
24.
25.
Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D (2007) A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Ann Epidemiol 17(8):584–590CrossRef
26.
Centers for Medicare and Medicaid Services. Chronic conditions data warehouse condition categories. 2019
27.
Cole SR, Hernan MA (2008) Constructing inverse probability weights for marginal structural models. Am J Epidemiol 168(6):656–664CrossRef
28.
Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107CrossRef
29.
Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706CrossRef
30.
Funk MJ, Westreich D, Wiesen C, Sturmer T, Brookhart MA, Davidian M (2011) Doubly robust estimation of causal effects. Am J Epidemiol 173(7):761–767CrossRef
31.
Ranapurwala SI, Naumann RB, Austin AE, Dasgupta N, Marshall SW (2019) Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base. Pharmacoepidemiol Drug Saf 28(1):4–12CrossRef
32.
33.
Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ (2014) Psychological and behavioral approaches to cancer pain management. J Clin Oncol Off J Am Soc Clin Oncol 32(16):1703–1711CrossRef
34.
Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL (2017) Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg 152(11):1066–1071CrossRef
35.
Lewis ET, Cucciare MA, Trafton JA (2014) What do patients do with unused opioid medications? Clin J Pain 30(8):654–662CrossRef
36.
Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer CJ, Binswanger IA (2016) Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One 11(1):e0147972CrossRef
37.
Howard R, Fry B, Gunaseelan V, et al. (2018) Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg :e184234
38.
Park KU, Kyrish K, Terrell J et al (2019) Surgeon perception versus reality: opioid use after breast cancer surgery. J Surg Oncol
39.
Tan WH, Yu J, Feaman S et al (2018) Opioid medication use in the surgical patient: an assessment of prescribing patterns and use. J Am Coll Surg 227(2):203–211CrossRef
40.
Paice JA, Toy C, Shott S (1998) Barriers to cancer pain relief: fear of tolerance and addiction. J Pain Symptom Manag 16(1):1–9CrossRef
41.
Potter VT, Wiseman CE, Dunn SM, Boyle FM (2003) Patient barriers to optimal cancer pain control. Psychooncology 12(2):153–160CrossRef
42.
Schumacher KL, West C, Dodd M et al (2002) Pain management autobiographies and reluctance to use opioids for cancer pain management. Cancer Nurs 25(2):125–133CrossRef
43.
Bulls HW, Hoogland AI, Craig D et al (2019) Cancer and opioids: patient experiences with stigma (COPES)—a pilot study. J Pain Symptom Manag 57(4):816–819CrossRef
44.
Bennett KG, Harbaugh CM, Hu HM et al (2018) Persistent opioid use among children, adolescents, and young adults after common cleft operations. J Craniofac Surg 29(7):1697–1701CrossRef
Metadata
Title
Cancer survivorship and its association with perioperative opioid use for minor non-cancer surgery
Authors
Samantha Eiffert
Andrea L. Nicol
Edward F. Ellerbeck
Joanna Veazey Brooks
Andrew W. Roberts
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 12/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-020-05420-1

Other articles of this Issue 12/2020

Supportive Care in Cancer 12/2020 Go to the issue

Original Article

Fear of cancer recurrence in haematological cancer patients: exploring socio-demographic, psychological, existential and disease-related factors

Original Article

Health information seeking behaviors among individuals with young-onset and average-onset colorectal cancer: an international cross-sectional survey

Original Article

Work- and insurance-related issues among Asian adolescent and young-adult cancer survivors: a qualitative study

Original Article

Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in gastrointestinal cancer patients with massive ascites treated with systemic chemotherapy

Review Article

Financial toxicity and employment status in cancer survivors. A systematic literature review

Editorial

MASCC 2020 recommendations for the management of immune-related adverse events of patients undergoing treatment with immune checkpoint inhibitors
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits