Patients with cancer were 10 times less likely to have deaths attributed to opioid use than the general population, according to a new retrospective study from researchers at Duke University in Durham, N.C. presented at the American Society of Clinical Oncology’s Quality Care Symposium on September 28, 2018 in Phoenix.
The study, conducted over a 10-year period (2006 to 2016), is the first to comprehensively explore the risks associated with opioid use among patients with cancer.
“Patients with cancer often rely on opioids to help manage their pain during treatment and to live comfortably with the disease,” said Fumiko Chino, MD, lead author of the study and a radiation oncologist with the Duke Cancer Institute. Without adequate pain management, patients can be forced to take breaks from lifesaving therapy or become hospitalized due to the side effects of treatment, he added. “This study should provide both oncologists and patients with some reassurance that opioids can be a safe and effective option for managing cancer-related pain.”
To determine the number of opioid deaths among patients with cancer, researchers evaluated death certificates from the National Center for Health Statistics where opioids were listed as the primary cause of death and cancer was noted as a contributing cause. For the general population, they reviewed certificates where opioids were listed as the primary cause but cancer was not mentioned. According to Dr. Chino, a limitation of this study is that the certificates did not provide any indication of the stage of cancer or treatment status at death. In addition, recent evidence suggests that opioid-related overdose deaths may be under-reported on death certificates because of incomplete cause-of-death reporting, indicating that the actual number of opioid-related deaths may be higher than it appears.
According to the death certificates, from 2006 to 2016, 895 deaths were caused by opioids in patients with cancer, compared with 193,500 in the general population. Researchers found that the incidence of opioid deaths increased significantly in the general population (from 5.33 to 8.97 per 100,000 people) but only slightly among patients with cancer (from 0.52 to 0.66 per 100,000). Deaths from opioid use were highest in patients with lung (22%), gastrointestinal (21%), head and neck (12%), hematological (11%), and genitourinary (10%) cancers.
Dr. Chino and colleagues noted that further research should explore how regulations to address the opioid crisis are affecting access to opioids for patients with cancer and the ability of their physicians to prescribe these medications to help manage
cancer-related pain.