Sunday, December 3, 2023
This activity is intended for hematologists/oncologists, pediatricians, family medicine and primary care practitioners, nurses, pharmacists, internists, physician assistants, and other members of the healthcare team for adolescents and young adults treated for sarcoma.
The goal of this activity is for learners to be better able to describe patterns of new persistent opioid use among adolescents and young adults in the year after treatment for sarcoma.
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CME / ABIM MOC / CE Released: 7/15/2022
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Nearly 80% of adolescents and young adults (AYAs) with cancer are expected to become long-term survivors. Minimizing their long-term treatment-related sequelae is essential to lower morbidity, optimize health-related quality of life (QoL), and improve long-term survival.
Potential for long-term opioid use among previously opioid-naive AYAs is of increasing concern. The Centers for Disease Control and Prevention states that AYAs are more likely than other age groups to misuse and overdose on opioids. Acute or chronic pain is an identified risk factor for opioid misuse in the general AYA population.
Young people with sarcoma may be at heightened risk for long-term opioid use after their cancer treatment.
In a nationally representative cohort of adolescents and young adults with sarcoma, nearly two-thirds took opioids during treatment, and almost one-quarter of those patients continued to use opioids after treatment ended.
"As a healthcare member, the finding that most adolescents and young adults treated for sarcoma receive opioid prescriptions is not surprising," lead author Melissa Beauchemin, PhD, RN, with Columbia University School of Nursing in New York, New York. "We use intense treatments to achieve the highest chance of a cure, and these treatments come with side effects. Opioids are very effective at preventing and treating pain, and they are often a key component of high-quality cancer care."
Still, "we were surprised" that nearly a quarter of patients who were prescribed opioids during treatment continued to use the painkillers after treatment, she said. "That to me is the important finding of this study."
Intense Treatment, Lingering Pain?
Adolescents and young adults with sarcoma experience disease- and treatment-related pain. Research shows that older patients are at high risk for persistent opioid use after therapy, but few studies have examined opioid use among younger patients.
Using the IBM MarketScan Research Database, Beauchemin and colleagues identified 938 patients with opioid-naive sarcoma aged 10 to 26 years. More than half (56%) were male, and 62% were aged younger than 18 years.
A total of 599 patients (64%) filled an opioid prescription during their cancer treatment. Of these patients, the number of opioid prescriptions ranged from 1 to 97; 44% received 1 prescription, 31% received 2 to 4 prescriptions, and 24% received 5 or more.
Overall, 77% (n = 464) of these patients discontinued opioid use after completing treatment. The other 23%, however, met criteria for new persistent opioid use: defined as filling at least 2 opioid prescriptions in the 12 months after the end of treatment.
In multivariable analysis that adjusted for age, pretreatment mental health (MH), and substance use (SU) disorders, having Medicaid insurance was associated with higher likelihood of new persistent opioid use compared with having commercial insurance (odds ratio [OR] 1.74).
Compared with patients with soft tissue sarcoma, patients with bone tumors -- specifically, Ewing sarcoma (OR 3.23) and osteosarcoma (OR 2.05) -- had significantly higher odds for new persistent opioid use after completing treatment.
"Our study provides new knowledge about the prevalence of opioid prescriptions and clinical factors, and future research should focus on optimizing pain management through safe and sustainable interventions and developing guidelines for safe opioid prescribing and monitoring," the authors wrote.
And, Beauchemin noted, "new persistent use may signal an inflection point at which clinicians can intervene, discuss with patients what the source of the pain might be, strategize how to reduce opioid exposure, and utilize other strategies to improve quality of life."
William Dahut, MD, chief scientific officer for the American Cancer Society, saidthat the study involved patients who would experience "significant pain" during their cancer treatment, particularly those who had bone sarcomas.
"It's a dilemma," said Dahut, who was not involved in the study, "because there's definitely a significant risk for opioid addiction. I think it just shows that we need to find newer and better ways to treat pain beyond opioids."
The study was partially funded by the National Cancer Institute, the Breast Cancer Research Foundation, the American Cancer Society, and the Herbert Irving Comprehensive Cancer Center. Beauchemin and Dahut have disclosed no relevant financial relationships.
