Gynecological Cancer

PV 04 - Poster Viewing Q&A - Session 4

TU_37_2727 - Opioid Use in Cervical Cancer Patients at Two Urban Medical Centers

Tuesday, September 17
2:45 PM - 4:00 PM
Location: ASTRO Innovation Hub

Opioid Use in Cervical Cancer Patients at Two Urban Medical Centers
R. Arya1, J. Jutzy1, K. Cotangco2, P. Peters3, E. W. Daily4, A. R. R. McCall1, A. R. Howard1, Y. Hasan5, R. Kothari2, and C. H. Son5; 1University of Chicago, Department of Radiation and Cellular Oncology, Chicago, IL, 2University of Illinois, Department of Gynecologic Oncology, Chicago, IL, 3University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Fransisco, CA, 4University of Chicago, Chicago, IL, 5Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, IL

Purpose/Objective(s): Cervical cancer patients are considered to be at a higher risk for opioid usage compared to other gynecologic cancer patients. This study aimed to characterize opioid prescribing patterns at two urban hospitals, including reasons for, timing, and duration of outpatient opioid use.

Materials/Methods: Clinical and demographic data from cervical cancer patients treated with curative intent from 2009-2017 were retrospectively collected. Women with persistent disease at 3 months following initiation of treatment or with chronic opioid use unrelated to cancer were excluded. Demographic, disease, treatment, and outpatient medication prescription practices were collected. Logistic regression, chi-squared, Cramer’s V, and Wilcoxon rank sum were used to assess strength of association between clinical or demographic variables with duration of opioid use. Endpoints included duration of opioid use ≥6 and ≥12 months.

Results: 67 women were included (34% white, 39% black, and 27% mixed/other; median age 51). FIGO distribution was: 34% stage I, 24% II, 34% III, and 8% IVA or unknown. Median follow up was 21 months. 88% received definitive radiotherapy (RT) and 12% received post-operative RT. Outpatient opioid prescriptions were written for 75% of patients and most commonly prior to initiation of any cancer therapy (31% of all patients); 11% were prescribed for routine post-procedure pain, and 18% during RT. Median duration of outpatient use was 3 [IQR 1-11] months. Of those who received outpatient prescriptions, 32% (24% of all patients) were prescribed for ≥6 months and 22% (16% of all patients) were prescribed for a ≥1 year. Higher BMI, black race, and initiation of opioids before treatment were associated with ≥6 months of opioid use (all p<0.05). There was no association between age, treatment modality, psychiatric history, marital status, or reason for initial opioid prescription with duration of use ≥6 or ≥12 months. There was a trend for use ≥6 months with recurrence (p=0.07). Other commonly prescribed medications included NSAIDs (40% of patients), lidocaine (24%), acetaminophen (21%), and gabapentin (8%). Of those receiving opioids, 34% did not receive any alternative pain medication.

Conclusion: The majority of women in this study were prescribed opioids prior to or during the course of cervical cancer treatment. While the median duration of use was 3 months, nearly one-quarter of these patients received ≥12 months of opioids. Prospective evaluation of these patients is needed to accurately identify factors associated with chronic opioid use and develop strategies for optimal management.

Author Disclosure: R. Arya: None. J. Jutzy: Employee; Rush University. K. Cotangco: None. P. Peters: None. E.W. Daily: None. Y. Hasan: Employee; Northwestern Memorial Hospital.

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