(103) Persistent Opioid Use in Lymphoma Survivors Following Treatment

Publication Number: 1148

Background: Opioid analgesia has an important role in treating cancer pain but can place survivors at risk for long-term adverse effects, including misuse, abuse, and overdose. Opioid use has been studied in surgical oncology patients, but little is known about long-term use and outcomes for patients with hematologic malignancies who primarily receive non-surgical treatment.

Objectives: To evaluate the association between opioid use during lymphoma treatment and persistent opioid use.

Methods: We conducted a cohort study using IBM Watson Health MarketScan Commercial Claims and Encounters Data from 2000-2019, containing claims for employer-sponsored privately insured individuals in the US. We identified opioid-naïve adults age 18-64 years at first diagnosis of Hodgkin (HL) or Non-Hodgkin lymphoma (NHL) who had outpatient cancer therapy lasting 90-240 days (including ≥3 episodes of outpatient chemotherapy). Using outpatient pharmacy claims, we categorized each patient’s opioid exposure during cancer treatment as no exposure, moderate [1-7 days supply], or high [>7 days supply]. Follow-up began 60 days after final cancer treatment and continued up to 365 days or until an outcome or censoring event. Persistent opioid use was defined as ≥120 days cumulative supply, ≥3 consecutive months of opioid prescriptions, or a prescription with ≥90 morphine milligram equivalents per day. We used time-to-event methods to estimate cumulative incidence and hazard ratios across exposure groups.

Results: The cohort included 4380 opioid-naïve lymphoma patients. 42.5% had HL and 57.5% had NHL. Median age at diagnosis was 46 years (IQR 32-56) and median treatment duration was 147 days (IQR 112-166). 55.0% of patients were male. During cancer treatment, 42.8% of patients had no opioid exposure, 28.1% had moderate, and 29.1% had high exposure. Among the no-opioid-exposure group, the 1-year cumulative incidence of persistent opioid use was 1.7%. Compared to this no-exposure group, hazard ratios for moderate and high exposure were 2.6 (95% CI 1.5-4.6) and 9.0 (95% CI 5.6-14.4), respectively, after adjustment for cancer treatment duration, age, cancer type, and calendar time. A sensitivity analysis comparing patients diagnosed 2000-2009 vs. 2010-2019 found that hazard ratios were consistent between the two time periods, but that absolute risks of long-term opioid use declined significantly over time.

Conclusions: Higher opioid exposure during cancer treatment was associated with higher risk of persistent opioid use in the year following cancer treatment. The absolute incidence of opioid use decreased over time and may be due to increased awareness of the opioid epidemic. Close clinical follow-up in the post-treatment period may be warranted for patients at high risk of adverse outcomes.