Time to discontinuation of opioids in patients with cancer after curative intent radiation.

Abstract

e18692 Background: Many providers expect that cancer survivors would be able to discontinue opioids soon after treatment, although this has not been well studied. The time cancer survivors that received curative intent radiation (CIR) remain on opioids and associated factors were examined. Methods: Electronic medical record data of cancer survivors between January 1, 2008 and December 31, 2018 and Kaplan Meier survival models were used to estimate time to discontinuation (TTD) of opioids. Cox proportional hazards models were employed to identify factors associated with TTD. Results: Median TTD was 16.8 months (95% CI: 13.1-19.1 months) following CIR and shorter for patients without opioid exposure prior to therapy (new persistent opioid use [NPOU]; 13.0 months, 95% CI: 10.0-17.3 months) compared to patients with opioid exposure prior to therapy (chronic opioid use [COU]; 21.4 months, 95% CI: 17.5-28.8 months) (p-value = 0.0004). NPOU (HR: 1.35, 95% CI: 1.07-1.71) compared to COU and head and neck (HR: 1.60, 95% CI: 1.01-2.53) in comparison to breast cancer were associated with shorter TTD. Surgery (HR: 0.68, 95% CI: 0.50-0.91), death (HR: 0.55, 95% CI: 0.34-0.91), alcohol use (HR: 0.63, 95% CI: 0.42-0.95) and nicotine use (HR: 0.78, 95% CI: 0.62-0.98) were associated with longer TTD. Conclusions: Cancer survivors receive opioids for almost 1.5 years after CIR. Patients receiving surgery and using alcohol or nicotine are at higher risk. Patients with NPOU or head and neck cancers have shorter TTD. Evidence-based guidelines for opioid use in cancer survivors are warranted due to opioid use following CIR.