Real-world patterns of pain medication use among patients with metastatic pancreatic ductal adenocarcinoma (mPDAC).

Abstract

302 Background: Helping patients manage cancer-related pain is an important aspect of supportive care. 80% of patients with mPDAC suffer from abdominal and/or back pain. Pancreatic cancer-related pain is typically treated pharmaceutically using pain medicines, which include opioids or narcotics. Previous studies have found that the presence of pain was associated with impaired survival in pancreatic cancer patients. The goal of this study was to assess the treatment patterns of pain medication usage and their association with duration of therapy (DOT) among patients with mPDAC treated in the real-world setting. Methods: This retrospective observational study utilized the IBM MarketScan Commercial and Medicare supplemental claims data. Data were analyzed for adult patients who were diagnosed with mPDAC and received treatment between January 2015 and March 2020. Patient characteristics and DOT were assessed. Opioid use during treatment including the number of prescriptions filled and average daily dose in morphine equivalents were summarized. Yearly and regional trends of opioid use were assessed. Results: There were 2,841 patients (median age: 61 years, IQR: 56-66) included in the study treated with first line (1L) therapies of interest. 55.6% (n = 1,579) of patients were male and 72.0% (2,046) had commercial insurance. The overall DOT in 1L was 78 days (IQR: 38 – 157). 54.3% of patients filled at least one prescription for opioids during treatment. The mean number of prescriptions filled during treatment was 2.2 (SD: 4.0) and the mean daily dose was 39.5mg morphine equivalents (SD: 134.6) The median DOT among patients who received at least one pain prescription was 92 days (IQR: 44 – 176) while those who did not receive pain medication experienced a DOT of 64 days (IQR: 29 – 135). Among the 1,248 patients who received second line treatment the median DOT was 60.5 days (IQR: 29 – 127). 50.6% (n = 632) filled at least one opioid prescription during treatment. Median DOT among patients who received pain medication was 73.5 days (IQR: 42 – 141) and 47.5 days (IQR: 15 – 103.5) among those who did not. Across lines of therapy opioid use remained stable during the study period ranging from 54.2% among patients treated in 2015 to 51.1% among those who initiated treatment in 2019. No regional differences were observed in prescription patterns within the four US census regions (range: 50.2 – 54.4%). Conclusions: In this real-world cohort of patients with mPDAC nearly half were prescribed at least one opioid during treatment. Patients who received opioids experienced a longer duration of therapy compared to those who did not. Further studies are needed to understand the association of pain control with improved clinical outcomes among patients with mPDAC.