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Purpose: Effective treatment with opioids for moderate-to-severe cancer pain depends on appropriate analgesic choice, dosing, monitoring, and side-effect management. This analysis aims to describe trends in real-world utilization of long acting opioids (LAOs) and chronic short acting opioids (SAOs) among cancer patients.
Methods: The Chronic Opioid Medication Use Evaluation (MUE) software analyzed 2010 OptumInsight ClinformaticsTM Data Mart pharmacy claims for enrollees with ≥1 LAO and/or chronic SAO (≥60days continuous therapy) claim. Cancer cohort was identified with primary or secondary diagnosis of cancer; the reference cohort consisted of patients without a cancer diagnosis. Study measures included daily average consumption (DACON), concomitant GI medication, and acetaminophen (APAP) use.
Results: A total of 26,732 and 78,059 unique patients comprised the cancer and reference population (mean age=54 and 49 years), respectively. Nearly 61% of cancer and 73% of reference patients were on chronic SAOs, and <20% of these had a concurrent LAO. LAO utilization was higher in cancer than reference patients (56% versus 46%). The most commonly filled LAOs in the cancer and reference samples were: oxycodone CR (33%, 33%), fentanyl transdermal (27%, 21%), and morphine CR/ER/SR (18%, 19%), respectively, with the DACONs for morphine CR/ER/SR (2.5, 2.5) and oxycodone CR (2.7, 2.8) above the recommended range. Average APAP daily dose of 3.1-4.0 gm/day and ≥4.0gm/day were observed for 5.4% and 1.5% of cancer and 5.2% and 1.2% of reference patients, respectively. About 16% of LAO and 19% of chronic SAO users in the cancer group began a GI prescription concurrently with or after starting opioid therapy, slightly higher than the reference group (11-13%).
Conclusion: Tools such as the Chronic Opioid MUE facilitate long-term monitoring of utilization and practice patterns for opioid treatment in cancer patients. This analysis identified APAP overload and chronic SAO use as potential areas of improvement for cancer and non-cancer pain patients.