Trajectories of Opioid Use Before and After Cancer Diagnosis: A Population-Based Cohort Study.

Daniels, B; Luckett, T; Liauw, W; Falster, MO; Gisev, N; Blyth, FM; Pearson, S-A

Trajectories of Opioid Use Before and After Cancer Diagnosis: A Population-Based Cohort Study.

Daniels, B Luckett, T

Liauw, W Falster, MO Gisev, N Blyth, FM Pearson, S-A

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Publisher:: ELSEVIER SCIENCE INC
Publication Type:: Journal Article
Citation:: Journal of Pain and Symptom Management, 2024, 68, (3), pp. 282-291.e11
Issue Date:: 2024-09

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Field	Value	Language
dc.contributor.author	Daniels, B
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Liauw, W
dc.contributor.author	Falster, MO
dc.contributor.author	Gisev, N
dc.contributor.author	Blyth, FM
dc.contributor.author	Pearson, S-A
dc.date.accessioned	2024-09-18T04:26:35Z
dc.date.available	2024-06-09
dc.date.available	2024-09-18T04:26:35Z
dc.date.issued	2024-09
dc.identifier.citation	Journal of Pain and Symptom Management, 2024, 68, (3), pp. 282-291.e11
dc.identifier.issn	0885-3924
dc.identifier.issn	1873-6513
dc.identifier.uri	http://hdl.handle.net/10453/180846
dc.description.abstract	BACKGROUND: Opioid use prior to cancer diagnosis increases the likelihood of long-term use during survivorship, however, patterns of use before and after diagnosis are not understood. METHODS: We used population-based dispensing data linked with cancer and death notifications to identify two cohorts of adults residing in New South Wales initiating opioids within 24 months prior to a first cancer diagnosed between 2014 and 2016: 'survivors' (alive 24 months following diagnosis) and 'decedents' (died within 24 months). We used group-based trajectory modelling to identify trajectories of monthly opioid dispensings and dispensed oral morphine equivalent milligrams (OMEmg) during the 24 months before/after cancer diagnosis. RESULTS: There were 21,843 survivors with four prediagnosis opioid dispensing trajectories: infrequent (58% of the cohort), late increasing (26%), moderate (10%), and sustained dispensing (6%). We observed an overall increase in dispensed OMEmg of 83 OMEmg (95% CI: 76-91) during the month of diagnosis, with strong opioid formulations comprising most treatment postdiagnosis. Within each prediagnosis opioid trajectory group, we observed five to six postdiagnosis trajectory groups, including no opioid dispensing. Moderate and sustained prediagnosis groups had large proportions of people continuing or increasing opioid dispensing after diagnosis, while small proportions discontinued opioid treatment. We observed similar trajectories in the decedent cohort. CONCLUSIONS: There is considerable heterogeneity in opioid use before and after cancer diagnosis. Our findings suggest noncancer factors drive a significant proportion of postdiagnosis opioid use, but use increased significantly from the month of cancer diagnosis and never returned to prediagnosis levels.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	ELSEVIER SCIENCE INC
dc.relation	http://purl.org/au-research/grants/nhmrc/1138442
dc.relation.ispartof	J Pain Symptom Manage
dc.relation.isbasedon	10.1016/j.jpainsymman.2024.06.006
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Anesthesiology
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Female
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Neoplasms
dc.subject.mesh	New South Wales
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Adult
dc.subject.mesh	Cancer Survivors
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Young Adult
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Middle Aged
dc.subject.mesh	New South Wales
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Young Adult
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Cancer Survivors
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Female
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Neoplasms
dc.subject.mesh	New South Wales
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Adult
dc.subject.mesh	Cancer Survivors
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Young Adult
dc.title	Trajectories of Opioid Use Before and After Cancer Diagnosis: A Population-Based Cohort Study.
dc.type	Journal Article
utslib.citation.volume	68
utslib.location.activity	United States
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Research Centres/IMPACCT
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Research Centres
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2024-09-18T04:26:32Z
dc.rights.holder	© 2024 The Authors.
pubs.issue	3
pubs.publication-status	Published
pubs.volume	68
utslib.citation.issue	3

Abstract:

BACKGROUND: Opioid use prior to cancer diagnosis increases the likelihood of long-term use during survivorship, however, patterns of use before and after diagnosis are not understood. METHODS: We used population-based dispensing data linked with cancer and death notifications to identify two cohorts of adults residing in New South Wales initiating opioids within 24 months prior to a first cancer diagnosed between 2014 and 2016: 'survivors' (alive 24 months following diagnosis) and 'decedents' (died within 24 months). We used group-based trajectory modelling to identify trajectories of monthly opioid dispensings and dispensed oral morphine equivalent milligrams (OMEmg) during the 24 months before/after cancer diagnosis. RESULTS: There were 21,843 survivors with four prediagnosis opioid dispensing trajectories: infrequent (58% of the cohort), late increasing (26%), moderate (10%), and sustained dispensing (6%). We observed an overall increase in dispensed OMEmg of 83 OMEmg (95% CI: 76-91) during the month of diagnosis, with strong opioid formulations comprising most treatment postdiagnosis. Within each prediagnosis opioid trajectory group, we observed five to six postdiagnosis trajectory groups, including no opioid dispensing. Moderate and sustained prediagnosis groups had large proportions of people continuing or increasing opioid dispensing after diagnosis, while small proportions discontinued opioid treatment. We observed similar trajectories in the decedent cohort. CONCLUSIONS: There is considerable heterogeneity in opioid use before and after cancer diagnosis. Our findings suggest noncancer factors drive a significant proportion of postdiagnosis opioid use, but use increased significantly from the month of cancer diagnosis and never returned to prediagnosis levels.

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http://hdl.handle.net/10453/180846