MedicalResearch.com Interview with:
Rinku Sutradhar, Ph.D.
Senior Scientist, Institute for Clinical Evaluative Sciences
Associate Professor, Dalla Lana School of Public Health
University of Toronto, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
- We suspected that pain was prevalent among survivors of cancer, but there were no comprehensive estimates on the magnitude of this prevalence. For example, recent work had reported pain prevalence among cancer survivors to be anywhere from 5% to 56%, which is quite a wide range.
- To our knowledge, there has been no prior research conducted at the individual-level that specifically examines opioid prescribing rates for cancer survivors, compared to matched control groups who have no prior cancer diagnosis.
- We also know that socio-economically disadvantaged populations are more at risk for opioid dependency, but previous studies have not examined cancer survivors who a part of this disadvantaged group, so this is an important knowledge gap to fill.
- We found that cancer survivors have significantly higher rates of opioid prescriptions compared with their matched controls (who had no prior cancer diagnosis). In fact, after adjusting for other study factors, we found that the rate of opioid prescriptions was 22% higher among survivors.
- MOST SURPRISING: This higher rate of opioid prescriptions persisted even among survivors who were 10 or more years past their cancer diagnosis (compared to matched control individuals who had no prior cancer diagnosis).
- When we broke the cohort down based on the type of cancer, we didn’t see a significant spike in opioid prescriptions for breast cancer survivors compared to their non-cancer controls, but we did see higher opioid prescriptions for survivors of lung, gastrointestinal, genitourinary, or gynaecological cancers, compared to their controls.
MedicalResearch.com: What should readers take away from your report?
- For some survivors, being cancer-free doesn’t necessarily mean being pain-free, for a variety of reasons. Pain lingering during survivorship could be associated with factors such as type and invasiveness of tumors, the type of treatments, other illnesses that may coincide with the cancer, and other aspects of the patient’s life such as their age, work situation, socioeconomic status, and so forth.
- Unfortunately opioids come with a high risk of dependency, which is why it’s important to have a comprehensive plan for how to manage any ongoing pain once individuals are cancer-free.
- Long-term cancer survivors are usually discharged from oncology clinics once they’ve reached 5 years without a recurrence. At this 5-year mark, their care is managed by their primary care physician. Our study suggests that family doctors treating cancer survivors should really look closely at the reasons for ongoing opioid use among their patients who are cancer survivors, both in terms of the health effects of long-term opioid use, as well as the higher risk of misuse and addiction.
- It may be important for cancer survivors to consider being cared for by specialized pain management teams that can offer a more integrative and holistic approach that includes a combination of drug therapy with opioids, along with physical therapy, regular exercise, and psychosocial interventions.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Now that we know survivors have a higher rate of opioid prescriptions, we need to examine the reasons why this may be occurring. That is, we need to the study the factors that may be associated with higher rates of opioid prescriptions among survivors.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our findings serve as an alert for cancer survivors and their primary care providers. It raises concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment. Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.
No disclosures to report
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Rinku Sutradhar, Armend Lokku, Lisa Barbera. Cancer survivorship and opioid prescribing rates: A population-based matched cohort study among individuals with and without a history of cancer. Cancer, 2017; DOI: 10.1002/cncr.30839
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