Impact of opioid use on health care utilization and survival in patients
with newly diagnosed stage IV malignancies
Received: 20 July 2017 /Accepted: 22 January 2018 /Published online: 2 February 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Patients with advanced cancers frequently experience pain. Opioids are commonly prescribed to treat cancer-related
pain, but their use might be associated with undesirable consequences including adverse effects and tumor progression, resulting
in increased heath care utilization and shorter survival. We examined these possibilities in a large cohort of patients diagnosed
with ten common advanced malignancies.
Methods We identified 1386 newly diagnosed patients with stage IV non-hematologic malignancies from 2005 to 2013 and
ascertained opioid utilization within 90 days of starting anti-cancer treatment using electronic medical record and tumor registry
data. Opioid utilization was stratified into low opioid (LO; < 5 mg oral morphine equivalents (OME)/day) and high opioid (HO;
≥ 5 mg OME/day). Health care utilization included tallies of emergency room, urgent care, and inpatient visits. The association of
opioid use, tumor type prognosis, age, and gender with overall survival was analyzed in univariate and multivariate models.
Results HO use patients (n = 624) had greater health care utilization compared to LO use patients (n = 762; p <0.05). HO use
patients also had shorter survival (median survival, 5.5 vs 12.4 months; p < 0.0001). On multivariate analysis, HO use remained
associated with shorter overall survival (HR 1.4; 95% CI, 1.3–1.6; p < 0.0001) after adjusting for age, gender, and prognostic group.
Conclusions In advanced cancer patients, HO use is associated with greater health care utilization and shorter survival.
Prospective studies using opioid-sparing approaches are indicated, to confirm these retrospective findings and to evaluate if
these undesirable effects associated with opioid use can be mitigated.
Health care utilization
Opioids are crucial to effectively treat cancer-related pain and
maintain quality of life [1, 2]. Approximately two thirds of
patients with advanced malignancies experience pain, often at
moderate-severe levels . Nearly 30% of all newly diag-
nosed cancer patients receive opioids within 2 months of a
diagnosis, and almost 60% receive opioids at some point dur-
ing their cancer course. Early integration of palliative care and
access to opioids are important aspects of the optimal care of
patients with cancer .
However, administration of opioids in cancer patients has
adverse effects including constipation, nausea, dizziness, and
respiratory depression [5, 6]. These symptoms may lead to
higher health care utilization and contribute to increased mor-
bidity and mortality. Lung cancer patients have more emer-
gency care (EC) and inpatient (IP) visits compared to other
cancer types, and these patients often experience more pain
and require more opioids . Whether opioids are associated
with greater health care utilization in patients with other ma-
lignancies is unclear.
Furthermore, in the USA, yearly deaths from opioid-
related causes continue to rise, and opioid overdose is
An abstract/poster describing preliminary study results presented at the
2015 American Society of Clinical Oncology Palliative Care in Oncology
Symposium in Boston, Massachusetts.
* Dylan Zylla
Frauenshuh Cancer Center, Park Nicollet Oncology Research and
HealthPartners Institute, 3800 Park Nicollet Blvd,
Minneapolis, MN 55416, USA
HealthPartners Institute, Minneapolis, MN, USA
Professional Data Analysts, Inc., Minneapolis, MN, USA
Hematology/Oncology Section, Department of Medicine,
Minneapolis VA Health Care System, Minneapolis, USA
Supportive Care in Cancer (2018) 26:2259–2266