Opioid Therapy for Cancer Pain May Be Associated With High Risk for Aberrant Opioid Use

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Investigators retrospectively reviewed charts of current or past patients diagnosed with cancer who received opioid treatment for ≥1 week.
Investigators retrospectively reviewed charts of current or past patients diagnosed with cancer who received opioid treatment for ≥1 week.

Patients taking opioids for cancer-related pain at outpatient supportive pain consultations may be at higher risk for aberrant opioid and drug use behavior, according to a study published in Cancer.

For this study, investigators at the University of Texas MD Anderson Cancer Center, retrospectively reviewed charts of current or past patients diagnosed with cancer who received opioid treatment for ≥1 week (n=751; eligible patients, n=729; 52% women; 70% white, 12% Hispanic, 11% black, and 5.6% Asian). The study's primary outcome was frequency of risk for aberrant opioid use, and factors associated with that risk. 

Factors examined were: patients' demographic information, symptom severity evaluated with the Edmonton Symptom Assessment System (ESAS), potential for aberrant opioid behavior evaluated with  the Screener and Opioid Assessment for Patients with Pain (SOAPP) tool, presence of alcoholism and illicit drug use assessed with  the Cut Down, Annoyed, Guilty, Eye-Opener Questionnaire Adapted to Include Drug Use (CAGE-AID).

A total of 143 participants were found to be SOAPP-positive (ie, scores ≥7), and 73 patients were CAGE-AID-positive. An association was established between CAGE positivity, CAGE score, male sex, and ESAS scores. A CAGE-AID score of 1 in 4 was found to predict a high risk for aberrant opioid use in study participants with  moderate sensitivity (43.3%), a positive predictive value of 53.2%, a  negative predictive value of 87.1%, and a specificity of 90.9%.

Study limitations included a lack of assessment of opioid use after supportive care clinic consultations, and a lack of information on nonmedical use of opioids.

“The current study indicated a high frequency of patients with cancer who had an elevated risk of aberrant opioid use behaviors. In routine clinical practice, this information would be helpful to clinicians for more careful monitoring of these patients with methods that might include more frequent encounters, lower prescription quantities, and potentially random UDS,” concluded the study authors.

Multiple authors declare conflicts of interest. Please see reference for a full list of authors' disclosures.


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Reference

Yennurajalingam S, Edwards T, Arthur JA, et al. Predicting the Risk for Aberrant Opioid Use Behavior in Patients Receiving Outpatient Supportive Care Consultation at a Comprehensive Cancer Center [Published online September 7, 2018]. Cancer. doi:10.1002/cncr.31670

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