Prevalence of Treatment With Opioids and Pain Among Patients with Urothelial Carcinoma

For patients with locally advanced or metastatic urothelial carcinoma, opioid use due to pain is consistently higher than in matched non-cancer controls according to a retrospective analysis. This pain is common at diagnosis and often worsens as the patient progresses.

In this analysis of claims, 1293 patients with locally advanced and metastatic urothelial carcinoma initiating treatment between May 2016 and June 2019 were identified, and matched on a 1:3 basis with 3862 non-cancer controls.

The date of the first systemic therapy claim for urothelial carcinoma treatment was considered the index date, 6 months pre-index was considered baseline, and time from the index date until disenrollment or study end was considered the follow-up. Among the outcomes assessed were proportion of treatment with opioids, the number of opioid prescriptions, and daily morphine-equivalent dose.

Treatment with opioids “represents a good proxy for assessing pain,” wrote Matthew D. Galsky, MD, Tisch Cancer Institute, New York, NY, and colleagues.

The mean follow-up was 1.26 years for patients with urothelial carcinoma and 1.29 years for the controls. The proportion of patients with urothelial carcinoma using opioids at baseline was 63.6% and at follow-up was 61.4%, compared to 19.4% and 27.9%, respectively, in the control group.

Among those patients using opioids, the number of opioid prescriptions was the same (0.55) in both groups at baseline, but was 0.49 for the urothelial carcinoma group and 0.39 for the control group at follow-up. The daily morphine-equivalent dose for the urothelial group was 53.6 at baseline and 74.7 at follow-up, compared to 45.7 and 40.8, respectively, for the controls. Additionally, the mean opioid prescriptions and the daily morphine-equivalent dose increased for patients with urothelial carcinoma during later lines of therapy.

Dr Galsky and colleagues noted, “The findings from this study highlight the importance of recognition and management of pain in the [locally advanced and metastatic urothelial carcinoma] population and the opportunity for new anti-cancer therapies to impact pain in these patients.”

Source:

Galsky M, Grewal S, Liu Y, et al. Treatment with opioids in patients with locally advanced or metastatic urothelial carcinoma and matched non-cancer controls. Urol Oncol. Published online August 1, 2022. doi:10.1016/j.urolonc.2022.06.013