Opioid Prescription After Pain Assessment: A Population-Based Cohort of Elderly Patients With Cancer
Abstract
Purpose The purpose of this study was to measure opioid prescription (OP) rates in elderly cancer outpatients around the time of
assessment for pain and to evaluate factors associated with receiving OPs for those with severe pain.
Patients and Methods
The cross-sectional cohort includes all patients with cancer in Ontario
older than age 65 years who completed a pain assessment
as part of a provincial initiative of systematic
symptom screening. Patients were assigned to mutually exclusive
categories
by pain score severity: 0, 1 to 3 (mild), 4 to 6
(moderate), and 7 to 10 (severe). We linked multiple provincial health
databases
to examine the proportion of patients with an OP
within 7 days after or 30 days before the assessment date. We examined
factors
associated with OPs for patients with pain
scores of 7 to 10.
Results The proportion
of patients with an OP increased as pain score severity increased: 10%
of those with no pain, 24% of those
with mild pain, 45% of those with moderate pain,
and 67% of those with severe pain. More specifically, for those with
severe
pain, 41% filled an OP within 7 days of
assessment for pain, and 26% had an OP from the 30 days before
assessment for pain,
leaving 33% without an OP. In multivariable
analysis, factors associated with OPs are younger age, male sex,
comorbid illness,
cancer type, and assessment at home.
Conclusion Despite a
generous time window for capturing OPs, the proportion of patients
without an OP seems high. Further knowledge
translation is required to maximize the impact
of the symptom screening initiative in Ontario and to optimize
management of
cancer-related pain.
