Icahn School of Medicine at Mount Sinai NEW YORK, NY
Haley M. Zylberberg, MD1, Sheila Rustgi, MD1, Anthony Yang, BA1, Sunil Amin, MD2, Aimee L. Lucas, MD, MS1; 1Icahn School of Medicine at Mount Sinai, New York, NY; 2University of Miami, Miami, FL
Introduction: Despite the high prevalence of pain in patients with pancreatic cancer, few studies have assessed whether pain relief impacts mortality. Given the ongoing opioid epidemic, determining whether opioid prescriptions can be harmful for patients with cancer is particularly important. The aim of this study was to investigate the association between opioid use and survival in patients with pancreatic cancer. Methods: Patients aged 65 years and older who were diagnosed with pancreatic cancer between 2007 and 2015 were identified using the Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linkage. Opioid use was defined as at least a 60-day supply within 1 year after cancer diagnosis. The association between opioid use and survival was examined using Kaplan Meier models. Propensity score analysis and Cox proportional-hazard models were used to determine the association between opioid use and survival, adjusting for relevant confounders such as sociodemographic characteristics, clinical symptoms, Charlson comorbidity index, stage and tumor location, ERCP after diagnosis, cancer treatment (chemotherapy, surgery and radiation), and use of post-operative opioids. Results: 19,653 patients with pancreatic cancer were identified; 3,128 (15.92%) of which used opioids 1 year after cancer diagnosis. Opioid users tended to be younger (74.4 vs 78.7 years), and were more likely to be female (58.7% vs 56.7%), not married (51.6% vs 46.3%), reside in non-metro areas (17.9% vs 15.7%), and have cholangitis (13.3% vs 11.3%) and pruritus (6.5% vs 5.2%), (all p < 0.05). The proportion of opioid users increased over time: 27.5% in 2007-2009, 33.5% in 2010-2012 and 39.0% in 2013-2016 (p< 0.0001). Mean survival time was increased in patients who used opioids (9.5 months) compared to non-users (5.3 months, p< 0.0001). After adjustment for confounders, opioid use was still associated with improved survival (HR 0.67, 95% CI 0.64-0.70). When stratified by type of opioid, improved survival persisted for all except meperidine. Discussion: Our findings suggest that treatment of pain with opioids confers a survival advantage in patients with pancreatic cancer. Physicians who treat patients with pancreatic cancer should be encouraged to adequately treat patients’ cancer related pain and be reassured that treatment even in an elderly population seems to improve mortality.
Disclosures: Haley Zylberberg indicated no relevant financial relationships. Sheila Rustgi indicated no relevant financial relationships. Anthony Yang indicated no relevant financial relationships. Sunil Amin indicated no relevant financial relationships. Aimee Lucas indicated no relevant financial relationships.