Oncology Rounds

An unintended side effect of cancer surgery: opioid dependence

by Deirdre Saulet and Julia Venanzi

Editor's note: This blog post was updated on June 13, 2018.

Due to the severity of the disease and treatment, opioids are a critical part of many cancer patients' chronic pain treatment plans. However, cancer patients are often excluded from the national conversation about opioid prescribing—and a new study shows this omission may be harmful.

Researchers at the University of Michigan examined a data set of national insurance claims of patients who underwent curative-intent surgery from 2010-2014. Up to 10% of this population are using opioids daily, and they're using them long after their surgical oncologist would expect them to. For example, one year after surgery, 10% of patients were filling prescriptions equivalent to six tablets per day of 5 mg hydrocodone, similar levels to those of chronic opioid users. In comparison, similar studies of non-cancer surgical patients showed 6% of patients continued to fill prescriptions in the same time frame. Patients who also received chemotherapy had an even higher risk of persistent opioid use, with 15 -21% continuing to use opioids past the recommended guidelines.

How surgical oncologists can help

The authors acknowledged that emotional trauma around a cancer diagnosis, pain from the surgical procedure, and coordinating pain management across a large care team are factors that may make a patient more vulnerable to opioid misuse. The research team at Michigan focused on what practice changes to should be made in order to reduce misuse in the future.

In addition to prescribing fewer opioids, the research team emphasized the importance of pain management education that highlights the risk of addiction. They are currently conducting follow-up research to determine how much pain medication patients actually use post-surgery, and intend to use those benchmarks to advise oncologists on how to prescribe lower amounts. The research team also emphasized the importance of pain management education that focuses on the risk of addiction.

 

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