Opioid-associated deaths in patients with cancer: A population study of the opioid epidemic over the past 10 years.

Abstract

230 Background: Over 40,000 Americans died due to opioid overdose in 2016; the epidemic is a top public health concern. Opioids are commonly used for cancer associated pain but it is unknown what risks for overdose exist in this vulnerable population. Methods: De-identified death certificate data was obtained via the National Center for Health Statistics. Death certificates contain 1 underlying cause of death and up to 20 contributing causes, as well as demographic data. All deaths due to opioids were included from 2006-2016; if present, cancer was noted as a contributing cause. Opioid death incidence was calculated from both the US and estimated cancer survivor population. Chi and R squared tests assessed for differences. Results: From 2006-2016, there were 895 deaths due to opioids in cancer patients compared to 193,500 in the non-cancer population. Opioid deaths increased from 5.33 to 8.97 per 100,000 people in the general population (significant time trend, p < 0.001, polynomial fit, R2 0.99). Opioid deaths increased in the cancer population from 0.52 to 0.66 per 100,000 (significant time trend, p < 0.001, linear fit, R2 0.24, slope = 0.018). Cancer patients who died due to opioid use were different from those who died due to opioids in the general population including: higher education (12.7 vs 6.9% at least a college degree), more women (38.5 vs 29.2%), fewer whites (82.3 vs 84.2%), more Hispanics (94.5 vs 91.3%), and fewer single patients (24.2 vs 48.1%) [all p < 0.001, except race p = 0.027]. Cancer patients also had older median age (57 years, IQR 50-65 vs median 42 years, IQR 31-51). 22% of opioid deaths were in lung cancer patients, followed by GI (21%), head & neck (12%), hematological (11%), and GU cancers (10%). Conclusions: Death from opioids as the primary cause noted on death certificates are 10 times less likely to occur in cancer patients versus the general population. There was a slight increase in opioid deaths in cancer patients; however, overall, there was not the sharp growth seen in the general population. Cancer patients at risk for opioid overdose are different than those at risk in the general population and care should be taken when planning effective treatment of cancer-related pain.