Patterns of pain medication use associated with reported pain interference in older adults with and without cancer
- 93 Downloads
Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing.
To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer.
Using the 2007–2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy.
Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication.
Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.
KeywordsPain treatment Opioids Pain interference Cancer Medicare part D Medicare health outcomes study
This study used data from the SEER-MHOS linked data resource. The authors acknowledge the efforts of the National Cancer Institute; the Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-MHOS database.
This research was funded through a contract with the National Cancer Institute (Contract HHSN261201700690P).
Compliance with ethical standards
Conflict of interest
EEK was a contractor for NCI and assisted with project oversight as well as contributing substantial intellectual input. AJD’s institution receives research funding from Celgene Corporation outside of the submitted project. CJP is a Paul Calabresi Scholar supported by the OSU K12 Training Grant for Clinical Faculty Investigators (K12 CA133250) and is a consultant for Potentia Metrics. SW’s institution receives funding from Genentech to support his research. No other author reports any conflict of interest to disclose. The research team had direct control of the data throughout the study project. We are unable to release the data to other researcher due to constraints of the Data Use Agreement with the NCI. However, we would be willing to provide SAS code for selection of medications identified in the analysis.
The interpretation and reporting of these data are the sole responsibility of the authors and do not reflect the positions of the National Cancer Institute, the Centers for Medicare & Medicaid Services, or the U.S. Department of Health and Human Services.
- 2.Institute of Medicine (2011) Relieving pain in America: a blueprint for transforming prevention, care, education, and research. National Academies of Science and Medicine, Washington, DCGoogle Scholar
- 6.Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Oncol Pract 32:4149–4154Google Scholar
- 7.Barbera L, Seow H, Husain A, Howell D, Atzema C, Sutradhar R, Earle C, Sussman J, Liu Y, Dudgeon D (2012) Opioid prescription after pain assessment: a population-based cohort of elderly patients with cancer. J Oncol Pract 30:1095–1099Google Scholar
- 9.Barbera L, Sutradhar R, Chu A, Seow H, Howell D, Earle CC, O'Brien MA, Dudgeon D, Atzema C, Husain A, Liu Y, DeAngelis C (2017) Opioid prescribing among cancer and non-cancer patients: time trend analysis in the elderly using administrative data. J Pain Symptom Manag 54:484–492CrossRefGoogle Scholar
- 16.Denlinger CS, Ligibel JA, Are M, Baker KS, Demark-Wahnefried W, Friedman DL, Goldman M, Jones L, King A, Ku GH, Kvale E, Langbaum TS, Leonardi-Warren K, McCabe M, Melisko M, Montoya JG, Mooney K, Morgan MA, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Raza M, Syrjala KL, Urba SG, Wakabayashi MT, Zee P, McMillian N, Freedman-Cass D, National Comprehensive Cancer Network (2014) Survivorship: pain version 1.2014. J Natl Compr Cancer Netw 12:488–500CrossRefGoogle Scholar
- 17.Centers for Disease Control and Prevention (2017) Calculating total daily dose. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
- 18.Center for Medicare & Medicaid Services (2017) Opioid oral morphine milligram equivalent (MME) conversion factors. Centers for Medicare and Medicaid Services, BaltimoreGoogle Scholar
- 21.Fisch MJ, Lee JW, Weiss M, Wagner LI, Chang VT, Cella D, Manola JB, Minasian LM, McCaskill-Stevens W, Mendoza TR, Cleeland CS (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Oncol Pract 30:1980–1988Google Scholar
- 32.Higginson IJ, Gao W (2012) Opioid prescribing for cancer pain during the last 3 months of life: associated factors and 9-year trends in a nationwide United Kingdom cohort study. J Oncol Pract 30:4373–4379Google Scholar
- 34.Vardy J, Agar M (2014) Nonopioid drugs in the treatment of cancer pain. J Oncol Pract 32:1677–1690Google Scholar
- 43.Olszewski AJ, Dusetzina SB, Eaton CB, Davidoff AJ, Trivedi AN (2017) Subsidies for oral chemotherapy and use of immunomodulatory drugs among Medicare beneficiaries with myeloma. J Oncol Pract 35:3306–3314Google Scholar