PCN250 PATTERNS AND PREDICTORS OF PAIN MEDICATION PRESCRIPTIONS AMONG BREAST CANCER PATIENTS IN OFFICE-BASED SETTINGS IN THE US

Abstract

Pain is a significant problem in patients with breast cancer. This study examined the prescribing practices of pain medications and factors associated with their prescriptions, with an emphasis on opioid prescribing, among office-based visits by women with breast cancer in the US. This retrospective cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) data from 2011-2016. The study included women (age>=18 years) with primary diagnosis of breast cancer identified using the International Classification of Diseases (ICD-9-CM and ICD-10-CM) codes. Pain medications were identified using American Hospital Formulary Service classification and Multum Lexicon codes. Weighted descriptive analysis examined the national level prescribing practices of pain medications in breast cancer, while multivariable logistic regression evaluated the factors associated with prescription of pain medications and opioids. Overall, there were (95% CI:19.29-28.60) outpatient visits for breast cancer during the study period. Pain medications were prescribed in 27.12 % (19.28-34.96) of these office visits; with opioids prescribed in 15.16% (8.75-21.57) and non-opioids in 17.13% (12.46-21.80) of the visits. Black race [OR=1.99 (1.18-3.35)], having Medicaid or other state-based program as payment source [OR=2.35 (1.16-4.77)], receiving adjuvant therapy [OR=4.82 (3.15-7.37)], visiting general/family practice physician [OR=2.13 (1.20-3.78)], were associated with greater likelihood of receiving pain medications; while patients in South region [OR=0.34 (0.12-0.97)] were associated with lower likelihood. Among the patients receiving pain medications, those in the Northeast [OR=0.16 (0.05-0.56)], Midwest [OR=0.13 (0.03-0.50)] and South [OR=0.16 (0.05-0.56)] regions were less likely to receive opioid prescriptions than patients residing in the West region. Patients receiving adjuvant therapy [OR=1.80 (1.01-3.22)] were more likely to be prescribed opioid medications. One in seven office visits by women with breast cancer involved opioids. Various demographic and provider characteristics are associated with prescription of pain medications and opioids. More research is needed to evaluate long-term consequences of opioid use in breast cancer.