Cancer Patients Much Less Likely To Die From Opioids Than General Public

This is a graph of opioid-related deaths from 2006-2016 with the rate per 100,000 tracked through time. The blue line is deaths in the general population and the orange line is in the cancer patient population. Deaths in the general population are increasing at an exponential rate and deaths in the cancer patient population are increasing at much lower (linear) rate. The gap between the two lines represents the difference in death rates with the cancer patient population with much lower rate of opioid-related death.A team of Duke Cancer Institute researchers led by radiation oncologist Fumiko Chino, MD, has found that death from opioids in the U.S. are 10 times less likely to occur in cancer patients and survivors versus the general population. These findings, Chino said, should “reinforce current policy that opioids for cancer related pain should continue to be excluded from restrictive prescribing laws meant to reign in the opioid epidemic.”

Chino, with co-authors Arif Kamal, MD, MBA, MHS, and Junzo Chino, MD, looked at all opioid-related deaths from 2006 to 2016; comparing those in the general population versus those with cancer noted as a contributing cause of death.

Over that 10-year period, 895 cancer patients died from opioids versus 193,500 in the non-cancer population. An increase in opioid deaths was found in both populations; from 5.33 to 8.97 per 100,000 people in the general population and from 0.52 to 0.66 per 100,000 in the cancer population.

According to the National Institute of Health, the number of overdoses due to opioids has risen yearly since 2002 and is expected to exceed 49,000 deaths in 2017. Opioids are commonly used for pain associated with cancer, said Fumiko Chino, MD, but it is unknown what risks for overdose exist in this vulnerable population.

“Many of our patients fear taking opioids for cancer related pain due to fear of becoming a statistic in the opioid epidemic,” she said. “Our research provides reassurance that opioid-related deaths in the cancer population are actually much rarer than in the population at large.”

Arif Kamal, MDSiblings Fumiko Chino, MD, and Junzo Chino, MD, co-authors of a study, with Arif Kamal, MD, comparing opioid associated deaths in cancer patients and survivors vs. the general population.The study team found that cancer patients and survivors who died due to opioid use were different from those in the general population who died due to opioids. They had a higher level of education, were more likely to be women (38.5 vs 29.2 percent), less likely to be white (82.3 vs 84.2 percent), more likely to be non-Hispanic (94.5 vs 91.3 percent), and less likely to be single (24.2 vs 48.1 percent). They also had an older median age (57 vs 42 years). Twenty-two percent of those cancer patients who died from opioids were patients and survivors of lung cancer, followed gastrointestinal cancers (21 percent), head & neck cancers (12 percent), hematological malignancies (11 percent), and genitourinary cancers (10 percent).

“There was a slight increase in patients with cancer opioid related death with time although not the catastrophic increase seen in the general public," said Fumiko Chino, MD. "Care should be taken when planning effective treatment of cancer-related pain.”

She will present “Opioid Associated Deaths in Patients with Cancer: A Population Study of the Opioid Epidemic over the past 10 years” as an oral abstract at the ASCO Quality Care Symposium on Friday, September 28, 2018.