Yale Study Finds Reduced Opioid Prescribing for Some Patients with Cancer

An analysis of opioid use and prescriptions for more than 10,000 Connecticut patients with cancer found modest decreases in both new and additional painkiller prescribing from 2016 to 2020, as reported Sept. 22 in Cancer.

The study also reported more dramatic declines in opioid prescribing in a few specific segments of this patient population, including those who reported no pain.

The review was initiated during peak concern about the opioid epidemic to determine whether national, state, and local measures aimed at curbing opioid use might adversely affect pain management for patients with cancer. The U.S. Department of Health and Human Services officially declared the opioid crisis a public health emergency in 2017.

“Our goal was to discover how policies designed to address the opioid crisis affected patients with cancer differently based their cancer stage, treatment type, and pain levels,” says senior author Henry S. Park, MD, MPH, a professor of therapeutic radiology and vice chair for clinical research at Yale School of Medicine.

The opioid use and prescription data that informed the study came from the Yale New Haven Health System Tumor Registry and electronic health records. The 10,232 adult patients were diagnosed from 2016 to 2020 with a first primary solid tumor malignancy. The majority were female (62%) and the mean age was 63.

• For patients reporting any pain, opioid prescribing stayed about the same, but it declined for those who reported no pain by 41%.

• The predicted probability of new opioid prescribing across all patients dropped from 71.1% in 2016 to 64.6% in 2020, coinciding with national efforts to reduce unnecessary opioid prescriptions.

• The predicted probability of new opioid prescribing for patients with metastatic cancer reporting no pain fell from 61.6% to 36.1%.

• For both patients undergoing surgery and those with metastatic cancer, the data revealed an approximate 8% decline in new opioid prescribing over the study period. The predicted probability of additional opioid use remained stable for those who had surgery and those with metastatic cancer.

“Our multi-disciplinary team built upon prior work by not only tracking the use of opioids in the cancer setting, but also homing in on how we are managing pain. At the end of the day, it’s vital to avoid overuse of opioids—when the harms would outweigh the benefits—but also to avoid underuse,” says study co-author Cary P. Gross, MD, professor of medicine (general medicine) at YSM.

In conclusion, Park says: “Our work suggests that patients with cancer who previously received preventative prescriptions even without pain may now be less likely to receive a prescription until they begin reporting pain. We hope that this data encourages patients with cancer to maintain open communication with their physicians about their symptoms so that they can access the right balance of opioid prescriptions at the right time.”

The study's first author is former Yale assistant professor Laura Van Metre Baum, MD, MPH.