High opioid (HO) use was associated with shorter survival and increased health care utilization (HCU) compared with low opioid (LO) use among patients with advanced cancer, according to a study published in Supportive Care in Cancer.

Opioids are the standard of care for the treatment of cancer-related pain and preservation of quality of life, but also lead to a high rate of adverse effects and potential overdoses. The association between HCU, survival, and opioid use requires further investigation.

For this retrospective study, researchers identified 1386 patients with newly diagnosed stage IV solid tumors and analyzed opioid usage records within 90 days of initiating anticancer therapies. Patients were stratified by LO usage (<5 mg oral morphine equivalents (OME)/day) and HO usage (≥5 mg OME/day); HCU was defined as the number of urgent care, inpatient, and emergency room visits. Baseline demographic characteristics were similar between HO and LO patients.

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Results showed that patients with HO use was significantly associated with increased HCU compared with LO. Approximately 33% of HO patients had 2 or more healthcare visits compared with 22% of LO use patients by 6 months, and increased HCU was sustained throughout the first year (P <.05).

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Patients with HO use had a shorter median survival of 5.5 months vs 12.4 months among patients with LO use (P <.0001); further analysis with multivariate models adjusting for age, gender, and prognostic group confirmed that median survival was reduced among HO use patients.

The authors concluded that “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.”


Zylla D, Steele G, Shapiro A, Richter S, Gupta P. Impact of opioid use on health care utilization and survival in patients with newly diagnosed stage IV malignancies [published online February 2, 2018]. Support Care Cancer. doi: 10.1007/s00520-018-4062-z