Duke Cancer Institute health services researcher Devon Check, PhD, is co-recipient of a two-year cross-institutional $466,440 grant from the National Institute on Aging to characterize population-level patterns of opioid and benzodiazepine co-prescribing among older adults with cancer and the risks of avoidable harms associated with this practice. More than half of people diagnosed with cancer in the U.S. are aged 65 years or older. This specific population of patients is the focus of the study.

The type of grant is an R21, which essentially allows investigators to explore and develop a research idea. Check’s co-principal investigator on this project is health services researcher and pharmaco-epidemiologist Aaron Winn, PhD (Medical College of Wisconsin). DCI geriatric oncology physician-researcher Harvey Cohen, MD, and palliative care and addiction medicine physician-researcher Jessica Merlin, MD, PhD, MBA-DGIM (University of Pittsburgh) are co-investigators on the project. Research staff from The Duke Endowment-funded Opioid Collaboratory round out the cross-institutional team. (The Opioid Collaboratory is led, managed, and administered through the Department of Population Health Sciences)

“Opioids are the mainstay of cancer-related pain management, and benzodiazepines are frequently prescribed to help patients manage other common symptoms of cancer and its treatment such as anxiety and trouble sleeping; up to 30% of patients are concurrently prescribed both types of drugs,” explains Check, an assistant professor in the Department of Population Health Sciences, Duke University School of Medicine. “Because prescribing both drugs together can increase the risk of opioid-related harms, this practice could have the unintended consequence of compromising patient well-being— particularly for older patients who are more prone to the effects of these drugs."

The project team will use cancer-related data collected by the National Cancer Institute SEER program (Surveillance, Epidemiology, and End Results), linked with Medicare data on opioid and benzodiazepine co-prescribing practices among older adults diagnosed with breast, colorectal, or lung cancer (some of the most common types of cancer in seniors.) They will also examine the risks associated with co-prescribing which could include falls, injury, and unintentional overdose.

Importantly, the team will conduct semi-structured interviews with providers to identify factors that influence their practices with respect to co-prescribing these two types of drugs and mitigating associated risks among older adults with cancer.

“We hope that the results of our study will serve to better inform and guide decision-making as to when co-prescribing benefits the patient and when it may contribute to avoidable harms,” says Check.

Per the National Institute on Aging, an estimated 65% of older adults report chronic pain, and the causes of pain and types of pain increase with age. Comorbidities (multiple types of diseases), the risk of drug interactions when taking many medications, age-related changes in drug metabolism, medication adherence, and adverse side-effects contribute to the complexity of pain management in this group.

In 2019, there were 54 million Americans ages 65 and older, or 19% of the U.S. population. By 2040, older adults will number 81 million, or 21% of the population.