Opioid Tapering in Older Cancer Survivors Does Not Increase Psychiatric or Drug Hospitalization Rates
Menée à partir de données des registres américains des cancers et de la base Medicare portant sur 15 002 patients ayant survécu à un cancer diagnostiqué entre 2010 et 2017, cette étude analyse l'association entre une diminution de l'utilisation d'opioïdes et la survenue d'événemenents indésirables, notamment de nature psychiatrique ou des hospitalisations liées à des overdoses médicamenteuses
Résumé en anglais
Background: Opioid tapering in the general population is linked to increases in hospitalizations or emergency department visits related to psychiatric or drug-related diagnoses. Cancer survivors represent a unique population with different opioid indications, prescription patterns, and more frequent follow-up care. This study sought to describe patterns of opioid tapering among older cancer survivors, and to test the hypothesis of whether older cancer survivors face increased risks of adverse events with opioid tapering.
Methods: Using the Surveillance, Epidemiology and End Results Medicare-linked database we identified 15,002 Medicare-beneficiary cancer survivors diagnosed between 2010 and 2017 prescribed opioids consistently for at least 6-months after their cancer diagnosis. Tapering was defined as a binary time-varying event occurring with any monthly oral morphine equivalent reduction of 15% or more from the previous month. Primary diagnostic billing codes associated with emergency room or hospital admissions were used for the composite endpoint of psychiatric or drug-related event(s).
Results: There were 3.86 events per 100 patient-months, with 97.8% events being mental health emergencies, 1.91% events being overdose emergencies and 0.25% involving both. Using a generalized estimating equation for repeated measure time-based analysis, opioid tapering was not significantly linked to acute events in the 3-month post-taper period (odds ratio 1.02; p = .62), nor at any point in the future (odds ratio 0.96; p = .46).
Conclusions: Opioid tapering in older cancer survivors does not appear to be linked to a higher risk of acute psychiatric or drug-related events, in contrast to prior research in the general population.
