ONCOmmunity

Opioid use disorder and overdose in older adults with breast, colorectal, or prostate cancer.

By: Andrew W Roberts, Samantha Eiffert, Elizabeth M Wulff-Burchfield, Stacie B Dusetzina, Devon K Check

Department of Population Health, Department of Anesthesiology, University of Kansas Medical Center (KUMC); University of Kansas Cancer Center 3901 Rainbow Blvd, Mailstop 1008, Kansas City, KS.
2019-09-23; doi: 10.1093/jnci/djaa122

Abstract

Background

Despite high rates of opioid therapy, evidence about the risk of preventable opioid harms among cancer survivors is underdeveloped. Our objective was to estimate the odds of opioid use disorder (OUD) and overdose following breast, colorectal, or prostate cancer diagnosis among Medicare beneficiaries.

Methods

We conducted a retrospective cohort study using 2007-2014 SEER-Medicare data for cancer survivors with a first cancer diagnosis of stage 0-III breast, colorectal, or prostate cancer at age 66-89 between 2008-2013. Cancer survivors were matched to up to 2 non-cancer controls on age, sex, and SEER region. Using Firth logistic regression, we estimated adjusted 1-year odds of OUD or non-fatal opioid overdose associated with a cancer diagnosis. We also estimated adjusted odds of OUD and overdose separately and by cancer stage, prior opioid use, and follow-up time.

Results

Among 69,889 cancer survivors and 125,007 controls, the unadjusted rates of OUD or non-fatal overdose were 25.2, 27.1, 38.9, and 12.4 events/10,000 patients in the non-cancer, breast, colorectal, and prostate samples, respectively. There was no association between cancer and OUD. Colorectal survivors had 2.3-times higher odds of opioid overdose compared to matched controls (adjusted odds ratio=2.33, 95% CI=1.49 to 3.67). Additionally, overdose risk was greater in those with more advanced disease, no prior opioid use, and pre-existing mental health conditions.

Conclusions

Opioid overdose was a rare, but statistically significant, outcome following stage II-III colorectal cancer diagnosis, particularly among previously opioid-naïve patients. These patients may require heightened screening and intervention to prevent inadvertent adverse opioid harms.