Publication date: Dec 03, 2019
Because pain is commonly associated with cancer, clinical questions understandably arise: Are patients with cancer especially at risk for opioid dependence or misuse?
A new study of US military veterans has found that the overall incidence of persistent post-cancer treatment opioid use was 8. 3% and was highest in patients who were previously chronic users.
“Our study attempts to create an objective clinical tool that can help give providers a better understanding of a patient’s risk of opioid-related toxicity,” study author Lucas K. Vitzthum, MD, resident physician in the Department of Radiation Medicine and Applied Science at the University of California San Diego, said in a statement.
Other research showed that 10% of patients who had surgery that was expected to cure the cancer were still filling opioid prescriptions 1 year after that surgery, with daily opioid doses similar to those in long-term opioid users.
In the current study, Vitzthum and colleagues sought to identify clinical risk factors as well as create a risk score that could help identify patients with cancer who might be at risk of persistent opioid use and abuse.
In a release, study coauthor James D. Murphy, MD, also from the University of California San Diego, noted that “opioids play an important role in helping patients with pain from cancer, or pain because of treatment.
“The score could be used early in the treatment course to identify patients at high risk for persistent opioid use,” she said.
David Hui, MD, associate professor in the Department of Palliative, Rehabilitation and Integrative Medicine at the University of Texas MD Anderson Cancer Center in Houston, pointed out that the study cohort was made up entirely of patients who were treated at the VA. “The VA population is unique, and may differ from the general population,” he said.
But overall, even in cancer patients there is a risk of opioid misuse, which this study demonstrates, he added.
Fumiko Chino, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City, “applauded the study authors in doing this important work in both highlighting opioid abuse risk factors and putting together a tool which may identify those at highest risk, ideally before they are prescribed new opioid medications. “
“Even for those patients at highest risk for abuse or persistent use, they may still require new or escalated opioid pain management during the course of their cancer treatment.
For example, a portion of former patients will require chronic pain medications in the long term, and appropriate use of these long-term opioids may allow them to return to a high level of function.
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Risk Factors |
| disease | MESH | Cancer |
| disease | MESH | opioid dependence |
| disease | MESH | military |
| disease | MESH | comorbidity |
| drug | DRUGBANK | Tropicamide |
| disease | MESH | death |
| disease | MESH | diagnosis |
| disease | MESH | recurrence |
| disease | MESH | liver cancer |
| disease | MESH | prostate cancer |
| pathway | KEGG | Prostate cancer |
| drug | DRUGBANK | Ethanol |
| disease | MESH | depression |
| drug | DRUGBANK | Methylphenidate |
| disease | MESH | sequelae |
| drug | DRUGBANK | Isoxaflutole |
| disease | MESH | chronic pain |
| drug | DRUGBANK | Nonoxynol-9 |
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