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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Risk of Persistent Opioid Use following Major Surgery in Matched Samples of Patients with and without Cancer

Mary Falcone, Chongliang Luo, Yong Chen, David Birtwell, Martin Cheatle, Rui Duan, Peter E. Gabriel, Lifang He, Emily M. Ko, Heinz-Josef Lenz, Nebojsa Mirkovic, Danielle L. Mowery, E. Andrew Ochroch, E. Carter Paulson, Emily Schriver, Robert A. Schnoll, Justin E. Bekelman and Caryn Lerman
Mary Falcone
1USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Chongliang Luo
2Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
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Yong Chen
2Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
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David Birtwell
1USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Martin Cheatle
3Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Rui Duan
2Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
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Peter E. Gabriel
4Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
5Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
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Lifang He
6Department of Computer Science and Engineering, Lehigh University, Bethlehem, Pennsylvania.
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Emily M. Ko
7Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
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Heinz-Josef Lenz
1USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Nebojsa Mirkovic
8Clinical Research Informatics Core, University of Pennsylvania, Philadelphia, Pennsylvania.
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Danielle L. Mowery
2Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
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  • ORCID record for Danielle L. Mowery
E. Andrew Ochroch
9Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
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E. Carter Paulson
10Department of General Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
11Department of Surgery, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
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Emily Schriver
8Clinical Research Informatics Core, University of Pennsylvania, Philadelphia, Pennsylvania.
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Robert A. Schnoll
3Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
5Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
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Justin E. Bekelman
4Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
5Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
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Caryn Lerman
1USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
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  • For correspondence: caryn.lerman@med.usc.edu
DOI: 10.1158/1055-9965.EPI-20-0628 Published November 2020
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Abstract

Background: The opioid crisis has reached epidemic proportions, yet risk of persistent opioid use following curative intent surgery for cancer and factors influencing this risk are not well understood.

Methods: We used electronic health record data from 3,901 adult patients who received a prescription for an opioid analgesic related to hysterectomy or large bowel surgery from January 1, 2013, through June 30, 2018. Patients with and without a cancer diagnosis were matched on the basis of demographic, clinical, and procedural variables and compared for persistent opioid use.

Results: Cancer diagnosis was associated with greater risk for persistent opioid use after hysterectomy [18.9% vs. 9.6%; adjusted OR (aOR), 2.26; 95% confidence interval (CI), 1.38–3.69; P = 0.001], but not after large bowel surgery (28.3% vs. 24.1%; aOR 1.25; 95% CI, 0.97–1.59; P = 0.09). In the cancer hysterectomy cohort, persistent opioid use was associated with cancer stage (increased rates among those with stage III cancer compared with stage I) and use of neoadjuvant or adjuvant chemotherapy; however, these factors were not associated with persistent opioid use in the large bowel cohort.

Conclusions: Patients with cancer may have an increased risk of persistent opioid use following hysterectomy.

Impact: Risks and benefits of opioid analgesia for surgical pain among patients with cancer undergoing hysterectomy should be carefully considered.

This article is featured in Highlights of This Issue, p. 2105

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2020;29:2126–33

  • Received April 27, 2020.
  • Revision received July 14, 2020.
  • Accepted August 20, 2020.
  • Published first August 28, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 29 (11)
November 2020
Volume 29, Issue 11
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Risk of Persistent Opioid Use following Major Surgery in Matched Samples of Patients with and without Cancer
Mary Falcone, Chongliang Luo, Yong Chen, David Birtwell, Martin Cheatle, Rui Duan, Peter E. Gabriel, Lifang He, Emily M. Ko, Heinz-Josef Lenz, Nebojsa Mirkovic, Danielle L. Mowery, E. Andrew Ochroch, E. Carter Paulson, Emily Schriver, Robert A. Schnoll, Justin E. Bekelman and Caryn Lerman
Cancer Epidemiol Biomarkers Prev November 1 2020 (29) (11) 2126-2133; DOI: 10.1158/1055-9965.EPI-20-0628

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Risk of Persistent Opioid Use following Major Surgery in Matched Samples of Patients with and without Cancer
Mary Falcone, Chongliang Luo, Yong Chen, David Birtwell, Martin Cheatle, Rui Duan, Peter E. Gabriel, Lifang He, Emily M. Ko, Heinz-Josef Lenz, Nebojsa Mirkovic, Danielle L. Mowery, E. Andrew Ochroch, E. Carter Paulson, Emily Schriver, Robert A. Schnoll, Justin E. Bekelman and Caryn Lerman
Cancer Epidemiol Biomarkers Prev November 1 2020 (29) (11) 2126-2133; DOI: 10.1158/1055-9965.EPI-20-0628
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