# Opioid prescription patterns in long-term disease-free cancer survivors: a retrospective analysis at a single NCI-designated comprehensive cancer center

## TL;DR

This study analyzed opioid prescription trends in cancer survivors who are disease-free and found that nearly 60% received increasing doses over two years.

## Contribution

The study identifies distinct opioid dose trajectory patterns and sociodemographic predictors in disease-free cancer survivors.

## Key findings

- 59.2% of disease-free cancer survivors on opioids experienced dose escalation over 24 months.
- Low-dose opioid users had two trajectory groups: discontinuers (61.7%) and escalators (38.3%).
- High-dose users escalated to up to 250 MMEs/day, with sex and race as significant predictors of continued opioid use.

## Abstract

This study examined opioid dose trajectory patterns in a cohort of disease-free cancer survivors who were at least 1 year out from completion of their cancer treatment at a single NCI-designated comprehensive cancer center.

We conducted a retrospective observational cohort study using electronic health records. Individuals diagnosed and treated for cancer with opioid prescriptions between 2004 and 2024 were identified through a combined review of ICD-10/ICD-9 codes. Inclusion criteria encompassed disease-free cancer patients who were prescribed opioids at least 1 year after completion of cancer treatment. Patients with cancer and sickle cell disease or receiving palliative care were excluded from the analysis. Prescriptions were standardized to average daily morphine milligram equivalent (MME) for a period of 24 months. Participants were classified as high-dose (≥ 50 MME/day) or low-dose (< 50 MME/day) persisters based on the strength of their average daily MMEs 1 year after completion of their cancer treatment. Prescription patterns were elicited using group-based trajectory modeling, and linear mixed-effects regression models.

A total of 1688 disease-free cancer survivors were identified, with 610 being prescribed opioids 1 year after completion of their cancer treatment. Low-dose persisters (n = 404) exhibited two trajectories: discontinuers (61.7%) and escalators (38.3%). Low-dose escalators increased from < 50 MMEs/day to an average of 100 MMEs/day at 24 months. High-dose persisters, i.e., individuals on ≥ 50 MMEs/day (n = 206) at 1 year after completion of their cancer treatment, exhibited escalating doses up to 250 MMEs at 24 months. Sex and race were the only sociodemographic characteristics found to be significant predictors of continued opioid exposure.

In our cohort of 610 disease-free cancer survivors on opioids at least 1 year after completion of their cancer treatment, 59.2% (n = 361) were prescribed escalating doses of opioids. Since higher opioid doses have been shown to be associated with increased risks of harm, future multicenter studies are needed to examine the factors associated with increasing opioid doses as well as intervention strategies to mitigate opioid escalation in disease-free cancer survivors.