University of Texas Medical Branch geriatric care specialist Dr. Mukaila Raji and a team of researchers have documented for the first time that rates of long-term opiate therapy — a 90-day or more supply of opioids per year — remain high among older cancer survivors and that those rates have risen regularly since 2004.
The data, drawn from the Texas Cancer Registry-Medicare linked database, showed that patients ages 66 and older who had been diagnosed with cancer at least five years before and who’d completed all cancer treatments still had a persistently high rate of long-term, prescribed opioid use, Raji said.
The results of the study were published recently in The Journal of the American Geriatrics Society.
“The rate of extended opioid therapy for cancer patients diagnosed in 2008 was 7.1 percent before their cancer diagnosis but rose to 9.8 percent within a year of cancer treatments and to 13.3 percent five years after diagnosis,” Raji said.
The team’s research built on previous work studying patterns of opioid use in different populations, this time looking at opioids legally prescribed to cancer patients.
Opioids are an important part of pain management for breast and lung cancer patients, for pain caused by the disease, by chemotherapy and surgery, healthcare providers say. But what Raji and his team were interested in was opioid use among cancer patients with no secondary cancer five years after they received their last treatments.
“We do know that, by that time, after using them for years and years, a significant amount of opioid use is associated with bad outcomes and has zero impact on chronic pain,” he said.
Raji emphasized that the study made no judgments about whether opioid use was appropriate or not for particular patients. But these findings, along with others studying long-term use of opioid medications, question the efficacy of continued therapy beyond its usefulness when patients are likely to develop dependency that can be associated with premature death.
“These are men and women who survived a potentially lethal condition, cancer, and continued taking medication that could prove to be lethal to them in the long-run,” Raji said.
While the medical community acknowledges that chronic pain, often neuropathic pain, among some cancer survivors can last for months, years or a lifetime, there have been growing concerns regarding long-term opioid therapy in older cancer survivors, a population at high risk of opioid toxicities, Raji’s team concluded. They were also concerned about rising rates of opioid prescriptions in 2004-2008 compared to 1995-1998 and 1999-2003.
All of this points to the need for safer and more effective pain treatment in elderly cancer survivors and the urgent need for better nationwide knowledge of patterns and outcomes of opioid therapy in the midst of a national opioid use crisis, especially as it applies to the rapidly growing population of elderly patients, Raji said.
“For any user of pain medication, it’s important to focus on what matters, and in the geriatric population what matters is being able to maintain quality of life,” he said. “If an opioid is the only treatment that allows a patient to remain functionally independent, so be it.”