An in-depth analysis conducted by Yale University has uncovered a modest decline in opioid prescriptions among over 10,000 cancer patients in Connecticut from 2016 to 2020. The findings, published on September 22 in the journal Cancer, highlight significant reductions in opioid prescribing, particularly among patients reporting no pain.
The study was initiated amid heightened concerns about the opioid epidemic, aiming to assess whether efforts to curb opioid use might inadvertently impact pain management for cancer patients. The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in 2017, underscoring the urgency of such research.
Understanding the Impact of Opioid Policies on Cancer Patients
According to Dr. Henry S. Park, senior author of the study and a professor at Yale School of Medicine, the research sought to understand how policies targeting the opioid crisis affected cancer patients differently based on their cancer stage, treatment type, and pain levels. “Our goal was to discover how policies designed to address the opioid crisis affected patients with cancer differently based on their cancer stage, treatment type, and pain levels,” Dr. Park explained.
The study utilized data from the Yale New Haven Health System Tumor Registry and electronic health records. It involved 10,232 adult patients diagnosed with a first primary solid tumor malignancy between 2016 and 2020. The patient group was predominantly female (62%) with a mean age of 63.
Key Findings and Statistical Insights
- For patients reporting any pain, opioid prescribing remained stable, while it decreased by 41% for those who reported no pain.
- The predicted probability of new opioid prescriptions across all patients dropped from 71.1% in 2016 to 64.6% in 2020, aligning with national efforts to reduce unnecessary opioid prescriptions.
- Among patients with metastatic cancer who reported no pain, the predicted probability of new opioid prescriptions fell from 61.6% to 36.1%.
- Both patients undergoing surgery and those with metastatic cancer experienced an approximate 8% decline in new opioid prescribing over the study period.
“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,” said Dr. Cary P. Gross, co-author of the study.
Implications for Pain Management in Cancer Care
The research suggests a shift in prescription practices, where patients with cancer who previously received preventative prescriptions without reported pain may now be less likely to receive such prescriptions until they begin experiencing pain. Dr. Park emphasized the importance of open communication between patients and physicians to ensure the appropriate balance of opioid prescriptions.
“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,” Dr. Park concluded.
Looking Ahead: Balancing Pain Management and Opioid Use
This study highlights the complex challenge of balancing effective pain management with the need to control opioid use. As the healthcare community continues to grapple with the opioid crisis, studies like this provide valuable insights into how policy changes impact specific patient populations.
The study’s first author, Dr. Laura Van Metre Baum, a former assistant professor at Yale, contributed significantly to this research, which underscores the need for ongoing evaluation of opioid prescribing practices in cancer care.
As healthcare providers and policymakers strive to refine opioid prescribing guidelines, the findings from this study could inform future strategies to ensure that cancer patients receive adequate pain management without contributing to the broader opioid crisis.
