By Brian Hoyle
SAN DIEGO -- November 19, 2018 -- A look at contemporary data from over 6,400 patients with cancer treated at a single centre has revealed the continued prevalent use of opiates for pain relief in the aftermath of radiation treatment.
While effective and warranted for some patients, this latest findings are disturbing in the light of the epidemic of opioid addiction in the United States and elsewhere.
The sobering news was reported here at the 2018 Palliative and Supportive Care in Oncology Symposium by Kyle Westbrook, MD, University of Texas Southwestern Medical Center, Dallas, Texas.
“More than 70% of patients with cancer use opiates after radiation,” the authors reported. “Significantly higher rates of opiate use are seen in those who receive chemotherapy, actively smoke, use alcohol, or have head and neck cancer. Patients treated with radiation for greater than 4 weeks have high rates of opiate use on year after treatment completion.”
The study looked at the medical records and follow-up data of 6,424 patients treated for head and neck cancer (n = 1,982), breast cancer (n = 2,932), and lung cancer (n = 1,510) at the University of Texas Southwestern Medical Center from 2009 to 2016. The majority of the patients were women (n = 4,307).
Opiate use was used for pain relief in 67% of women and 76% of men. Patients with head and neck cancer had significantly (77%; P
The most common opiate used was hydrocodone (95.14%), followed by morphine (17.23%), fentanyl (12.79%), oxycodone (9.30%), and hydromorphone (8.97%).
The same pattern of prevalence held for the different cancers, with hydrocodone used for pain relief by 94.77% of patients with head and neck cancer, by 98.17% of patients with breast cancer, and by 90.20% of patients with lung cancer.
Opiates were used more often for patients who received chemotherapy compared with those who did not (82% vs 68%), for active smokers versus never smokers (76% vs 66%), and for current drinkers versus non-drinkers (76% vs 67%; P
When radiation treatment lasted longer than 1 month, 8.8% of the patients were still receiving opiates 1 year after completing therapy.
Gabapentin was prescribed for pain relief in 18.7% of women and in 15.9% of men. Those receiving gabapentin were more likely to use ≥3 opiates.
“Our hope is that this and future studies establishing baselines of prescribing patterns will allow for prospective trials comparing established and proposed interventions for pain control in these patients,” the authors concluded.
[Presentation title: Prevalence and Usage Patterns of Opiates in Patients With Lung, Breast, and Head and Neck Cancer. Abstract 120]
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