Outpatient use of opioids was associated with worse pain outcomes and higher opioid consumption among patients with cancer who present to the emergency department (ED) with pain. These study findings were published in JCO Oncology Practice.

Within the first year of a cancer diagnosis, nearly half of all patients have an ED encounter, and often present with pain. This prospective cohort sought to identify predictors for pain outcomes and opioid consumption during ED visits in patients with cancer. At the Brigham and Women’s Hospital between 2020 and 2021, pain outcomes and opioid consumption were evaluated on the basis of demographics and clinical characteristics of 175 patients.

The patients included in this study comprised 54.5% women; 80.9% were White; the most common diagnosis was colorectal (15.2%), breast (11.2%), ovarian (11.2%), or lung (10.2%) cancer; 56.7% had stage IV disease; 76.3% had metastatic disease; 82.0% had received chemotherapy; and 47.6% received their diagnosis during the previous year.

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Lower income (P =.015), fewer depressive symptoms (P =.035), greater pain catastrophizing (P ≤.001), outpatient opioid use (P ≤.001), and precancer history of chronic pain (P =.019) were independent predictors of pain severity.

A college education (P =.021), greater pain catastrophizing (P =.004), anxiety (P =.047), outpatient opioid use (P ≤.001), and sleep disturbance (P =.001) were predictors of pain interference.

Hourly opioid administration was higher among patients currently using opioids in the outpatient setting (P =.002).

Patients who used outpatient opioids (42.1%) were younger, had lower health literacy, and higher rates of advanced cancer, depression, anxiety, sleep disturbance, and pain catastrophizing compared with nonusers.

This study was conducted during the COVID-19 pandemic, which interrupted recruitment and may have influenced patients to avoid hospital exposure until their symptoms were more severe.

This study found that worse pain outcomes in the ED were associated with psychosocial distress and outpatient opioid use among patients with cancer. Future study is needed to determine whether earlier identification of and intervention for pain-related risk factors may improve outcomes.

Disclosure: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Azizoddin DR, Beck M, Flowers KM, et al. Psychological evaluation of patients with cancer presenting to the emergency department with pain: independent predictors of worse pain severity, interference, and higher hourly opioid administration. JCO Oncol Pract. Published online August 22, 2022. doi:10.1200/OP.22.00142