Pain, substance use, and opioid prescribing in a prospective cohort with advanced cancer (GP138)

Outcomes 1. Understand the demographic, clinical characteristics, and pain severity of the participants enrolled into a prospective cohort study of opioid benefits and harms.2. Apply the evidence, recognize potential important harms and benefits to opioids for pain management in patients with advanced cancer. Key Message The evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Here, we present the baseline characteristics, particularly pain, substance use, and opioid prescribing, of a prospective cohort developed to investigate the benefits and harms of opioid prescribing in individuals with advanced cancer. Importance There is limited evidence available to guide opioid-related decision-making in individuals with advanced cancer.(1,2) For example, the risks with benzodiazepines co-prescribing, substance use, or overdose. Objective(s) To fill the urgently needed clinical and research gap on opioid benefits and harms in individuals with advanced cancer, we describe baseline cohort characteristics as of 10/13/2023. Scientific Methods Utilized This study is a multisite longitudinal cohort study using patient reported outcomes (PROs) (10/2022-present). Participants have a recent (within 12 weeks of enrollment) advanced cancer diagnosis and maximal opioid exposure of less than 90 consecutive days in the prior year. PRO measures include the Pain, Enjoyment, and General Activity (PEG scale).(3 ) Additionally, participants complete surveys on demographics, mortality risk and substance use history. Results A total of 154 participants completed baseline assessments. Cohort demographics include mean age 66 years; 42% were female; 79% identified as White, 12% Black, and 11% Hispanic. The most common cancers were prostate (19%), lung (16%), and pancreatic (12%). With a look back period of 3 months, 46% reported potentially problematic use of alcohol, 20% cannabis, and 1% prescription opioids. The mean PEG score on a 0 to 10 scale was 2.3 (SD=2.6). Thirty-six percent were prescribed opioids in the three months prior to enrollment. Fifty-two percent of participants had a low risk of two-year mortality. Conclusion(s) We have recruited 154 participants with advanced cancer and anticipate recruiting 630 participants by November 2024. The cohort reported mild pain severity, one-third were prescribed opioids at baseline and nearly half reported risky alcohol use. These rates mirror declining pain severity and opioid prescribing but indicate slightly higher substance use rates than recent literature. (4,5) Subsequent aims will investigate opioid benefits/harms and conduct qualitative interviews to understand opioid-related decision-making in patients, clinicians, and caregivers. Impact Successful study completion will inform future interventions guiding opioid-related decision-making in individuals with advanced cancer.