Patterns of opioid prescription, use, and costs among patients with advanced cancer and inpatient palliative care between 2008 and 2014

Sriram Yennurajalingam, Zhanni Lu, Suresh K. Reddy, Eden Mae C. Rodriguez, Kristy Nguyen, Marie J. Waletich-Flemming, Kyu Hyoung Lim, Aksha Memon, Nhu Nhu Nguyen, Kristy W. Rofheart, Guoqin Wang, Srikanth Reddy Barla, Jimin Wu, Janet L. Williams, Eduardo Bruera

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations

Abstract

PURPOSE An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 (P, .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years (P = .03). The median MEDDs increased from IPC to discharge by 67% (P, .001). The median Edmonton Symptom Assessment Scale pain improvement at followup was 1 (P, .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P, . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P, .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [P = .004] v 0.30 [P = .02]) and tended to use high MEDDs. 75 mg/d) during hospitalization. CONCLUSION The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

Original languageEnglish (US)
Pages (from-to)E74-E83
JournalJournal of oncology practice
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2019

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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