High Risk for Persistent Opioid Use in Young People With Sarcoma

Young people with sarcoma may be at heightened risk for long-term opioid use following their cancer treatment.

In a nationally representative cohort of adolescents and young adults with sarcoma, nearly two thirds took opioids during treatment, and almost one quarter of those patients continued to use opioids after treatment ended.

“As a clinician, the finding that most adolescents and young adults treated for sarcoma receive opioid prescriptions is not surprising,” lead author Melissa Beauchemin, PhD, RN, with Columbia University School of Nursing in New York City, told Medscape Medical News. “We use intense treatments to achieve the highest chance of a cure, and these treatments come with side effects. Opioids are very effective at preventing and treating pain, and they are often a key component of high-quality cancer care.”

However, “we were surprised” that nearly a quarter of patients who were prescribed opioids during treatment continued to use the painkillers after treatment, she said. “That to me is the important finding of this study.”

The study was published online May 23 in the journal Cancer.

Intense Treatment, Lingering Pain?

Adolescents and young adults with sarcoma experience disease- and treatment-related pain. Research shows that older patients are at high risk of persistent opioid use following therapy, but few studies have examined opioid use among younger patients.

Using the IBM Marketscan claims database, Beauchemin and colleagues identified 938 opioid-naive sarcoma patients aged 10 to 26 years. More than half (56%) were male, and 62% were younger than 18 years.

A total of 599 patients (64%) filled an opioid prescription during their cancer treatment. Of these patients, the number of opioid prescriptions ranged from one to 97; 44% received one prescription, 31% received two to four prescriptions, and 24% received five or more.

Overall, 77% (n = 464) of these patients discontinued opioid use after completing treatment. The other 23%, however, met criteria for new persistent opioid use — defined as filling at least two opioid prescriptions in the 12 months following the end of treatment.

In multivariable analysis that adjusted for age, pretreatment mental health, and substance use disorders, having Medicaid insurance was associated with higher likelihood of new persistent opioid use compared with having commercial insurance (odds ratio [OR], 1.74).

Compared with patients with soft tissue sarcoma, those with bone tumors — specifically, Ewing sarcoma (OR, 3.23) and osteosarcoma (OR, 2.05) — had significantly higher odds of new persistent opioid use after completing treatment.

“Our study provides new knowledge about the prevalence of opioid prescriptions and clinical factors, and future research should focus on optimizing pain management through safe and sustainable interventions and developing guidelines for safe opioid prescribing and monitoring,” the authors write.

And, Beauchemin noted, “new persistent use may signal an inflection point at which clinicians can intervene, discuss with patients what the source of the pain might be, strategize how to reduce opioid exposure, and utilize other strategies to improve quality of life.”

William Dahut, MD, chief scientific officer for the American Cancer Society, told Medscape Medical News that the study involved patients who would experience “significant pain” during their cancer treatment, particularly those who had bone sarcomas.

“It’s a dilemma,” said Dahut, who wasn’t involved in the study, “because there’s definitely a significant risk for opioid addiction. I think it just shows that we need to find newer and better ways to treat pain beyond opioids.”

The study was partially funded by the National Cancer Institute, the Breast Cancer Research Foundation, the American Cancer Society, and the Herbert Irving Comprehensive Cancer Center. Beauchemin and Dahut have disclosed no relevant financial relationships.

Cancer. Published online May 23, 2022. Full text

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