Abstract 4817: Patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015
Authors: Chen Yingxi , Shin Yei-Eun , Spillane Susan , Shiels Meredith , Coghill Anna , Enewold Lindsey , Pfeiffer Ruth , Freedman Neal 
Published: March 2024

Introduction: Understanding factors associated with opioid dispensing in cancer patients is important for developing tailored guidelines and ensuring equitable access to pain management. We examined patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015.

Methods: We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims. We included the most common cancer types among patients aged 66-95 years. Opioids dispensed within 30 days before and 120 days after cancer diagnosis were assessed. We used logistic regression models to examine trends, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) for opioid dispensing, considering patient demographics, geography, cancer stage, comorbidities, and treatment options.

Results: A total of 211,759 cancer patients aged 66-95 years were included in the study. Moreover, opioid dispensing increased from 16.4% within 30 days pre-diagnosis to 59.8% within 120 days post-diagnosis. Variations were observed across cancer types, with the largest increase among female breast cancer patients (74.9%, n=44,544). We observed significant increases over calendar time in opioid dispensing within120 days post-diagnosis in both women (p=0.02) and men (p=0.001). For all cancers combined, non-Hispanic Black men had a significantly lower likelihood of receiving opioids during the 120 days post-diagnosis (aOR=0.9, 95% CI=0.8-0.9) compared to non-Hispanic White men. Factors such as pre-diagnosis opioid dispensing, age, geography, cancer stage, comorbidities, and type of cancer treatment were associated with opioid dispensing during the 120 days post-diagnosis. Surgery had the strongest association, with men undergoing surgery being 4.4 times more likely to receive opioids within 120 days post-diagnosis (aOR=4.4, 95% CI=4.2-4.6), while women had an odds ratio of 2.7 (95% CI=2.6-2.8). Chemotherapy and radiotherapy were also positively associated with opioid dispensing, though the associations were less pronounced. Moreover, compared to urinary bladder cancer, patients with kidney cancer (women, aOR=1.6, 95% CI=1.5-1.8; men, aOR=1.7, 95% CI=1.5-1.8), lung cancer (women, aOR=1.4, 95% CI=1.3-1.5; men, aOR=1.5, 95% CI=1.4-1.6), and female breast cancer (aOR=1.8, 95% CI=1.6-1.9) were more likely to receive opioids within the 120 days post-diagnosis.

Conclusion: This population-based study reveals significant variations in opioid dispensing among cancer patients over age 65 across cancer types and demographic and clinical factors. Further research is needed to address disparities and optimize opioid dispensing in older cancer patients, ensuring tailored guidelines and improving patient care.

Citation Format: Yingxi Chen, Yei-Eun Shin, Susan Spillane, Meredith Shiels, Anna Coghill, Lindsey Enewold, Ruth Pfeiffer, Neal Freedman. Patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4817.