Pain requiring opioids is more common among patients with locally advanced or metastatic urothelial carcinoma (UC) than in patients without cancer and it worsens as disease progresses, according to a recent study.
The findings highlight the importance of recognition and management of pain among patients with locally advanced or metastatic UC “and the opportunity for new anti-cancer therapies to impact pain in these patients,” Matthew D. Galsky, MD, of the Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai in New York, New York, and colleagues concluded in Urologic Oncology.
The study included 1293 patients with locally advanced or metastatic UC and a control group of 3862 patients without cancer matched exactly by age and gender at the index date for patients in the UC group. The investigators defined the index date as the date of a first systemic therapy claim for locally advanced or metastatic UC. The patients with UC were compared with patients without cancer to characterize the additional pain burden attributed to locally advanced or metastatic UC. At the index date, the cancer and control groups had a mean age of 64.1 and 64.8 years, respectively. The mean follow-up duration was 1.26 years for the cancer group and 1.29 years for the control group.
Compared with the control group, the cancer group had a higher proportion of patients who used opioids during both baseline (63.6% vs 19.4%) and follow-up (61.4% vs 27.9%), Dr Galsky and colleagues reported. The investigators defined baseline as the 6 months preceding the index date.
Among patients who used opioids, mean monthly prescriptions (number of medication claims/patient/month) at baseline were 0.55 in both the cancer and control arms and 0.49 and 0.39, respectively, during follow-up. The daily morphine-equivalent dose (MEQ; morphine milligram equivalents/d) was 53.6 and 45.7, respectively, during baseline and 74.7 and 40.8 during follow-up, Dr Galsky and colleagues reported.
Mean opioid prescriptions and daily MEQ increased during later lines of therapy in the cancer group, according to the investigators.
Galsky MD, Grewal S, Liu Y, et al. Treatment with opioids in patients with locally advanced or metastatic urothelial carcinoma and matched non-cancer controls. Urol Oncol. Published online August 1, 2022. doi:10.1016/j.urolonc.2022.06.013