Outcomes of Discontinuing Long-Term Opioid Therapy Among Older Cancer Survivors in Long-Term Care Settings.

Abstract

Objectives: Clinical decisions to continue or discontinue long-term opioid therapy (LTOT; ≥3 months) for older cancer survivors remain challenging due to limited evidence on the risks and benefits of this treatment practice. This study aims to examine the associations of discontinuing LTOT with clinical and opioid-related adverse event (ORAE) outcomes among older cancer survivors residing in long-term care (LTC) settings.

Designs: This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.

Setting and participants: LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.

Methods: Discontinuation of LTOT was defined as no prescription opioid refills for at least 90 days. Clinical outcomes included worsening pain, physical function, and depression; ORAE outcomes included counts of pain-related hospitalizations, pain-related emergency department visits, opioid use disorder, and opioid overdose. We used modified Poisson models for clinical outcomes and Poisson models for ORAE outcomes, adjusting baseline covariates via inverse probability of treatment weighting.

Results: Of 21,861 episodes of cancer survivors with LTOT, 18,984 survivors (86.8%) continued LTOT, whereas 2877 survivors (13.2%) discontinued LTOT. The discontinuers vs continuers had lower adjusted risk of worsening pain (relative risk 0.65, 95% CI 0.59-0.74, P < .001) and lower adjusted rates of opioid use disorder (rate ratio 0.76, 95% CI 0.64-0.90, P < .001) and opioid overdose (rate ratio 0.33, 95% CI 0.21-0.52, P < .001) at the 1-year follow-up, with no difference in physical function and depressive symptoms or rates of pain-related hospitalizations and emergency department visits.

Conclusions and implications: Discontinuing vs continuing LTOT was associated with lower risk of worsening pain, opioid use disorder, and opioid overdose, with nondifferential risks of the other studied outcomes. Discontinuing vs continuing LTOT may confer benefits that outweigh risks among older LTC cancer survivors.