The Effect of the Opioid Epidemic on Cancer Survivors

Researchers recently evaluated how the opioid epidemic in the United States has impacted cancer survivors by analyzing opioid-associated deaths in this population over a 10-year period.

“More than 40 000 people in the US died owing to opioids in 2016; the epidemic tops public health concerns. Opioids are commonly used for cancer-associated pain, and there has been a call for oncologists to become more aware of opioid-related risks and benefits. It is unknown, however, if opioid-related deaths in cancer survivors are rising at the same rate as in the general population,” the researchers explained, writing in JAMA Oncology.

The National Center for Health Statistics (NCHS) was queried for death certificate data, which include one underlying cause and up to 20 contributing causes of death, as well as demographic data. Deaths caused by opioids between 2006 and 2016 were assessed, and cancer as a contributing cause was noted when applicable. NCHS data were used to calculate opioid-related death incidence from both the U.S. population as well as the estimated cancer survivor population; χ² and R² tests were used to determine differences.

Opioid Deaths Not Increasing at Same Rate of General Pop

During the study period, 193,000 deaths in the general population were attributable to opioids, and 895 in the cancer population. In the general population, the number of opioid-related deaths per 100,000 people increased from 5.33 to 8.97 (P<0.001; R² = 0.99); in the cancer survivor population, it increased from 0.52 to 0.66 (P<0.001; R² = 0.24).

Demographic characteristics differed between the two groups. Cancer survivors who died an opioid-related death, compared to the general population, were more likely to have at least a college degree (12.7% vs. 6.9%) and be female (38.5% vs. 29.2%) and non-Hispanic (94.5% vs. 90.7%); they were less likely to be white (82.3% vs. 84.2%) and single (24.2% vs. 48.1%) (P<0.001 for all, expect race; P=0.03). The median age for cancer survivors was 57 years, compared to 42 years for the general population. In cancer survivors, the most common primary cancer was lung (22.3%), followed by gastrointestinal (20.9%), head and neck (11.7%), hematologic (11.3%), prostate/urinary (10.1%), breast (7.0%), and gynecologic (4.9%).

The researchers summarized that while opioid-related deaths have increased among the cancer survivor population, it has not been at the same rate as that of the general population.

“Cancer survivors at risk for opioid overdose may be different from people in the general population, including being older with higher educational attainment; these differences may, in part, reflect the diagnosed cancer population. Additionally, some diagnoses may carry higher proportional risk; patients with head and neck cancer represent 12% of opioid-related deaths but less than 4% of new cancer diagnoses,” the researchers speculated.

“In summary, opioid-related deaths in the cancer population are much rarer than in the general population. Continued care should be taken when treating cancer-related pain,” they concluded.