New analysis finds more than half of U.S. adolescents and young adults with sarcoma, a type of cancer in the bones or soft tissues, are often prescribed opioids to treat their pain. Nearly one-quarter of these patients continue to use opioids after treatment is completed according to findings published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Individuals with sarcoma often develop damaged and fractured bones and undergo major surgical operations, and to help manage patients' pain, physicians may prescribe opioids. It is unclear whether this increases these young patients' risk for opioid misuse and overdose.
Melissa Beauchemin, Ph.D., RN, CPNP-PC, CPON, of Columbia University School of Nursing, and her colleagues sought to determine the rate of new persistent opioid use among adolescents and young adults treated for sarcoma. Persistent opioid use was defined as at least two opioid prescriptions in the 12 months after treatment was completed.
The team drew from a large insurance claims database to analyze information on patients aged 10–26 years old who had not received prior opioids and who were diagnosed with sarcoma between 2008 and 2016.
Among the 938 patients in the analysis, 64% received opioid prescriptions during treatment. After completing cancer therapy, 14% of patients overall and 23% of those who used opioids during treatment continued to use opioids and met the criteria for new persistent use. Being covered by Medicaid versus commercial insurance, having bone tumors versus soft tissue tumors, and receiving concurrent lorazepam (a medication often used to treat anxiety and sleeping problems) were associated with persistent opioid use.
"Adolescents and young adults are a vulnerable population because they have benefitted less than younger and older cancer patients from recent advances. These results highlight the need to monitor young patients with sarcoma for posttreatment opioid use, given the potential negative impacts of long-term opioid use, including misuse and overdose," said Dr. Beauchemin. "Age- and developmentally appropriate strategies to effectively manage pain while minimizing opioid exposure are urgently needed."
Dr. Beauchemin stressed that for adolescents and young adults who require opioids for effective pain management, early and safe discontinuation of opioids to reduce long-term negative effects of their use and misuse should be prioritized. "Further, there is a critical need for clinical practice guidelines to support clinical decision making to safely and effectively manage pain specifically for adolescents and young adults with cancer," she said.