Study Finds Patients With Cancer Are Less Likely to Die of Opioid Overdose

Fumiko Chino, MD

Despite changes affecting how oncologists prescribe and manage opioid use among their patients, there are few data analyzing the frequency and extent to which patients with cancer die of opioid overdoses.

Fumiko Chino, MD, a radiation oncologist at Duke University School of Medicine in Durham, North Carolina, set out to shed some light on this poorly understood aspect of the opioid epidemic. She and 2 colleagues at Duke used National Center for Health Statistics death certificate data to create a dataset that included all US deaths for which opioid overdose was listed as the primary cause of death during a 10-year period.

The investigators then analyzed death certif-icates for people who had fatal overdoses but also listed cancer as a contributing cause of death. They calculated the opioid death incidence from the estimated cancer survivor population and the US population as a whole.

Chino, who presented the data at the 2018 ASCO Quality Care Symposium, reported that there were 895 opioid-related deaths in patients with cancer between 2006 and 2016. This compares with 193,500 such deaths in the US population as a whole.

Notably, the incidence rates of opioid deaths increased during that time in both populations, but the increase was much lower among patients with cancer. In the general population, opioid deaths rose from 5.33 to 8.97 per 100,000 people (P <.001). In the cancer population, opioid deaths increased from 0.52 to 0.66 per 100,000 people (P <.001) during the same 10-year period.

For Chino, these results provide reassurance that opioid-related deaths in the cancer population are much rarer than in the general population. At the same time, there is cause for concern, she said: “Even though our population’s overdose risks were proportionately lower than the general public’s, the numbers of fatal overdoses are still rising over time.”

William Dale, MD, PhD, who helped organized the Quality Care Symposium, said that Chino’s research was a strong addition to the symposium. “We know that studies based on death certificate data are limited by the subjectivity of the physician who fills out each death certificate, but Dr Chino took a methodologically appropriate approach to begin to get answers on whether our patients are more or less vulnerable to opioid over-dose than the general population,” he said. “We now have solid evidence to suggest that people with cancer are at a lower risk of death related to opioid use than the general popula-tion, which is important information for us as prescribers.”

Chino CL, Kamal AH, Chino JP. Opioid associated deaths in patients with cancer: a population study of the opioid epidemic over the past 10 years. Presented at: 2018 ASCO Quality Care Symposium; September 28-29, 2018; Phoenix, AZ. Abstract 230. meetinglibrary.asco.org/record/166352/abstract