Beyond the pain: Decoding opioid use in advanced cancer ED visits.

Abstract

298 Background: Patients with advanced cancer often turn to the emergency department (ED) for pain treatment, impacting their quality of life and escalating healthcare costs. A crucial step in reducing avoidable ED visits and maintaining patient safety is to identify the characteristics of this patient group and explore potential intervention points. This study aims to characterize the use of narcotics in the ED among patients with advanced cancer. Methods: This retrospective cross-sectional study at Kaiser Permanente Northern California involved adults aged 18 and older diagnosed with Stage IV solid cancers between 2018 to 2020, who had at least one ED visit and passed away within one year (excluding those who died within 30 days). Demographics, clinical variables, frequencies, and trends in ED visits were collected and compared based on opioid utilization. Results: The study encompassed 2,554 patients with 6,406 ED visits in their final year of life. Sixty-one percent of these patients received opioids during their ED visits, with a median of three visits per patient. Pain scores taken at triage of these visits showed 23% reported severe pain, 23% moderate pain, and 7% mild pain. In 56% of visits, patients had filled an opioid prescription within the last 30 days. Morphine (39%) and hydromorphone (29%) were the most commonly administered opioids, primarily intravenously (66%). The prevalent cancer subtypes receiving opioids during ED visits were breast, head and neck, and upper GI. Among patients who received chemo or radiation, 65% received opioids during ED visits, compared to the 55% of patients not in treatment. For treated patients, chemotherapy was associated with increased ED visits requiring opioid pain management. Median survival did not differ significantly between those who received opioids during ED visits (130 days) and those who did not (123 days). Conclusions: This study emphasizes the dynamic pain needs of patients with cancer at the end of life driving utilization of emergency care. Factors influencing these needs include cancer subtype and current treatment status, particularly chemotherapy. Further studies are essential to enable providers to better recognize cancer pain and to improve patient safety by addressing changes in patients' pain requirements outside the emergency setting.