Trends in New and Persistent Opioid Use in Older Adults with and without Cancer
Menée à partir de données américaines portant sur 238 470 personnes (âge : 66-94 ans), cette étude de cohorte rétrospective analyse l'évolution de l'utilisation des opioïdes en fonction de la présence d'un cancer ou non
Background: The impact of ongoing efforts to decrease opioid use on patients with cancer remains undefined. Our objective was to determine trends in new and additional opioid use in patients with and without cancer. Methods: This is a retrospective cohort study using data from SEER-Medicare for opioid-naïve patients with solid tumor malignancies diagnosed from 2012 through 2017, and a random sample of patients without cancer. We identified 238,470 eligible patients with cancer and further focused on 4 clinical strata: patients without cancer, patients with metastatic cancer, patients with non-metastatic cancer treated with surgery alone (“surgery-alone”), and patients with non-metastatic cancer treated with surgery plus chemotherapy and/or radiotherapy (“surgery+”). We identified new, early additional, and long-term additional opioid use and calculated the change in predicted probability of these outcomes from 2012 to 2017. Results: New opioid use was higher in patients with cancer (46.4%) than in those without (6.9%) (p < 0.001). From 2012 to 2017, the predicted probability of new opioid use was more stable in the cancer strata (relative declines: 0.1% surgery alone; 2.4% surgery+; 8.8% metastatic cancer), compared to the non-cancer stratum (20.0%) (p < 0.001 for each cancer to non-cancer comparison). Early additional use declined among surgery patients (-14.9% and -17.5% for surgery alone and surgery+, respectively), but was stable among metastatic patients (-2.8%, p=.50). Conclusions: Opioid prescribing declined over time at a slower rate in patients with cancer than in patients without cancer. Our study suggests important but tempered effects of the changing opioid climate on patients with cancer.