(145) The Link Between Prescription Opioid Intensity and Fall Events in Older Cancer Patients

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 819

Presenting Author(s)

Christy A. Xavier
– University of North Texas Health Science Center, UNT Health Science Center, Fort Worth, Texas, United States

Co-Author(s)

walter agbor
– The University of North Texas Health Science Center at Fort Worth, Kansas City, Missouri, United States
Neal Bhachawat
– UNT Health Science Center, United States
Rafia Rasu, BPharm, MPharm, MBA, PhD
– Professor, University of North Texas Health Science Center, TX, United States

Background: Cancer pain is a complex process often treated with opioids. Yet, it is unknown what types of opioids can exacerbate fall events, especially in older cancer patients.

Objectives: Evaluate the types and intensity of prescribed opioids associated with fall events in older cancer patients in the U.S.

Methods: This cross-sectional study analyzed opioids prescribed to manage acute or chronic pain in older (>65) cancer patients. Population data was compiled (2006-2017) from National Ambulatory Medical Care Survey (NAMCS). The independent variable was opioid prescription users. Opioid-only users were defined as patients prescribed only an opioid (no benzodiazepines) for pain management. Opioids were further categorized as either high (HIOP) or low intensity (LIOP). The dependent variable, fall, was identified with ICD9/10 codes. Descriptive statistics, survey weights, and unadjusted and adjusted logistic regressions were conducted in STATA 16.

Results: Of 10,007,639 (weighted) cancer patient visits (patient age:74.9±6.9), the estimated national proportion of patients on opioids was 12%. Of patients on opioids, 12% were on HIOP, and 88% were on LIOP. When evaluating adverse events, fall risk was 75% and 48% for HIOP and LIOP users, respectively. The odds of fall events in patients on HIOP was almost 3 times (AOR:3.09,95%CI:1.01-9.47) higher compared to patients on LIOP. Of HIOP, methadone was the most significantly associated with falls (P < 0.001), whereas oxycodone was significantly associated with falls for LIOP (P=0.03). Patients on acetaminophen and opioids concurrently were almost twice as likely to incur a fall event if they were on HIOP (P=0.21). Patients on concurrent NSAIDs had two times lower odds of falling if they were on a HIOP (P=0.23).

Conclusions: HIOP, when prescribed to older patients with cancer, are associated with nearly 3-fold fall events, but this needs further investigation. Concurrently prescribing acetaminophen or NSAID may also have a clinically important effect on fall risk, even though it is not statistically significant. Tight control with rigorous treatment guidelines in prescribing HIOP to this patient population may help in addressing the issue of fall events. Decision makers may need to be more vigilant when determining the type of opioids to prescribe and increase monitoring of fall-related adverse events in older cancer patients on HIOP and other pain medications.