New research suggests that it may be possible to predict which mesothelioma patients are at risk for opioid addiction.
The research comes from the University of California. Scientists analyzed more than a hundred thousand cancer cases to come up with a list of risk factors for opioid addiction.
The information could help doctors select other, less dangerous ways of managing pain in high risk mesothelioma patients.
Mesothelioma Pain and Opioid Addiction
Chest pain is a symptom of pleural mesothelioma. People with peritoneal mesothelioma may experience abdominal pain. As the disease progresses or lung fluid builds up, that pain can impact quality of life. Many mesothelioma patients also experience pain after surgery.
Managing pain is a significant part of care for patients with mesothelioma or other types of cancer. Opioid drugs like fentanyl, methadone, and morphine are powerful pain relievers. But they can also lead to opioid addiction, especially for certain people.
The US Department of Health and Human Services says 42,000 people died from opioid overdoses in 2016. An estimated 40 percent of those deaths involved prescription drugs.
Other studies exist on opioid addiction risk. But the University of California researchers say there is not enough data on cancer-specific pain and opioids.
Assessing the Risks for Cancer Patients
The research team conducted a retrospective study of 106,732 cancer survivors in the Veterans Administration database. They excluded patients with hematologic cancers (like lymphoma or leukemia) or skin cancer.
They determined how many of the patients ended up using opioids long-term, how many abused opioids, and how many were hospitalized for overdoses.
The researchers used the data to compile a list of risk factors for opioid addiction among cancer patients. “A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors for persistent opioid use,” they write.
Who is at Risk from Opioids?
The study showed that 8.3 percent of cancer patients had “persistent opioid use”, putting them at higher risk for opioid addiction. The rate of persistent use was highest among people who had never had an opioid prescription before.
The rate of opioid addiction or abuse was 2.9 percent overall and 2.1 percent in the opioid-naive patients.
Patients at lowest risk for opioid addiction included
- Older patients
- Employed patients
- African Americans
- Patients living in higher-income zip codes
High risk factors included
- History of alcoholism
- History of drug abuse
- Multiple health problems (comorbidities)
The researchers conducted independent tests to validate their findings. “An independent test set showed a high level of accuracy in predicting persistent opioid use, future diagnoses of opioid abuse or dependence, and admission for opioid abuse or toxicity,” concludes the report.
About 2,500 people receive a mesothelioma diagnosis in the US each year. Opioid prescriptions are “standard of care” for mesothelioma surgery patients.
A 2018 study in JAMA Oncology suggested that minimally invasive lung cancer surgery could reduce the risk of opioid addiction in by reducing pain.
Vitzthum, L, et al, “Predicting Persistent Opioid Use, Abuse and Toxicity Among Cancer Survivors”, September 1, 2019, Radiation Oncology, https://www.redjournal.org/article/S0360-3016(19)31359-8/fulltext
Tuminello, S, et al, “Opioid Use After Open Resection or Video-Assisted Thoracoscopic Surgery for Early-Stage Lung Cancer”, November 2018, JAMA Oncology, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584254/