No Sharp Growth Seen in Patients, Survivors of Cancer as Part of Opioid Epidemic

The oncology community is not immune to the opioid crisis that is killing thousands of Americans each year. However, patients with cancer are 10 times less likely to have an opioid-associated death, according to recent research conducted at Duke University.

The researchers looked at anonymous death certificates from the National Center for Health Statistics, which list one underlying cause of death, and up to 20 contributing causes, as well as demographic information. Information was collected between the years 2006 and 2016.

“This research is essential because we had no modern assessments of what the actual risk for opioid overdose is in the cancer patient population are, and if that rate was rising rapidly like in the general population,” study author Fumiko Chino, M.D., radiation oncologist at Duke University, said in an interview with CURE.

“We were hoping to find that the risk for opioid overdose was lower in the cancer patient population. This is what had previously been shown in some limited retrospective data from prior to the rapid rise of deaths in the Opioid Epidemic. We are surprised by how different the groups really were though and how substantially lower the risk for opioid overdose was in this vulnerable population.”

In the allotted time frame, there was a total of 895 opioid-related deaths in the cancer population compared to 193,500 in the non-cancer population. However, both groups saw increased percentages of death from opioids — from 5.33 to 8.97 per 100,000 people in the non-cancer population, and .52 to .66 in the cancer population.

“The United States is in the midst of the Opioid Epidemic with over 100 Americans dying due to opioid-related deaths every single day. We know that over the past several years, access to opioid medication has been reduced for both patients who are on active cancer treatment and for cancer survivors with chronic cancer-related pain,” Chino said.

Patients with cancer who were more likely to die of opioid use differed than those without cancer who had the same cause of death; such demographics included higher education (12.7 percent versus 6.9 percent had at least a college degree); more females (38.5 percent versus 29.2 percent); fewer white patients (82.3 percent versus 84.2 percent); more Hispanic patients (94.5 percent versus 91.3 percent), and fewer single patients (24.2 percent versus 48.1 percent). Patients with cancer who had opioid-related deaths were also older (median age, 57 years vs 42 years) than those in the non-cancer population.

The variances of opioid-related deaths found among both groups may point toward the differing demographics of the cancer population, Chino explained.

“For example, patients are typically diagnosed with cancer later in life and thus those cancer patients who died were substantially older,” she said. “The differences do highlight, however, that providers cannot just rely on stereotypes for who is ‘at risk’ and that we need to do specific opioid risk assessments and careful monitoring of all of our patients who require opioid medications for pain.”

In the cohort of patients with cancer who died as a result of opioid use, the majority had lung cancer (22 percent) followed by gastrointestinal cancers (21 percent), head and neck cancers (12 percent); blood cancers (11 percent) and genitourinary cancers (10 percent).

The majority of these differences are due to the incidence and prevalence of diagnoses, Chino said, noting that lung cancer accounts for approximately 14 percent of all new cancer diagnoses and 25 percent of cancer deaths each year.

However, the high incidence of opioid-related deaths in the head and neck cancer population was something that she found striking, considering the disease only accounts for about 4 percent of new diagnoses and 2 percent of cancer deaths on a yearly basis.

“This is certainly very concerning and may highlight a specific patient population which may benefit from closer monitoring and careful risk assessment given the baseline patient characteristics and potential coexisting risk for substance abuse disorder,” Chino said.

She added how this research can help others realize that, despite the epidemic, the cancer population is not dying from opioids at nearly as high a rate as the general population.

“In terms of policy, national and state legislators continue to consider ways to reign in the Opioid Epidemic. Our study has given some evidence that cancer-related pain should continue to be excluded from prescribing restrictions,” she said.

However, Chino added, while patients with cancer might not see these results as big a spike in opioid-related deaths, it is still important that patients and providers act with care when prescribing and taking these medications.