(067) Clinical outcomes of discontinuing long-term opioid therapy among older cancer survivors in nursing homes

Background: The US Centers for Disease Control and Prevention CDC Guideline for Prescribing Opioids for Chronic Pain recommends tapering or discontinuing long-term opioid therapy (LTOT) for patients with chronic pain when risks outweigh the benefits of LTOT. Despite the guideline explicitly stating that its recommendation does not apply to patients with cancer, doctors including oncologists have been prescribing fewer opioid medications for older patients, raising a question regarding the benefit and risk of discontinuing LTOT for cancer survivors who depend on opioids for pain relief, including those living in nursing homes (NHs).

Objectives: To investigate associations of discontinuing vs continuing LTOT with pain, physical function, and depressive symptoms among older NH cancer survivors.

Methods: This is a retrospective cohort study. The setting included a 100% Medicare NH sample linked to the Minimum Data Set (MDS) from 2010 to 2021. The study sample included older (≥65) long-term (≥2 years) residents who were cancer survivors and received LTOT for ≥90 days in a 12-month nursing home stay. Residents entered the cohort on the 90th day of the latest LTOT episode. Residents who received ongoing cancer treatment, palliative, or hospice care were excluded. The key exposure was discontinuation of LTOT, defined as no opioid refills for ≥90 consecutive days in 1 year after cohort entry. The primary outcomes were pain, physical function, and depression, assessed using MDS assessments. We used a separate logistic model with IPTW to model the adjusted proportion of individuals with a worsening outcome from baseline to each quarterly follow-up assessment among residents who discontinued vs continued LTOT. A generalized estimating equation was used for estimation to account for within-individual correlation.

Results: A total of 53,141 cancer survivors who received LTOT were identified, consisting of 62,387 patient observations. Of 62,387 patient observations, 51,357 residents (82.3%) continued LTOT, and 11,030 (17.6%) discontinued LTOT. Residents who discontinued (vs continued) LTOT had lower odds of worsening pain (adjusted odds ratio [AOR], 0.64, 95% CI, 0.59-0.59, P < .001) and depressive symptoms (AOR, 0.92 [95% CI, 0.85-0.99]; P = .033), with no difference in physical function (AOR, 0.96 [95% CI, 0.89-1.03]; P = .226) during the 1-year follow-up.

Conclusions: Among older nursing home residents who were cancer survivors, discontinuing vs continuing LTOT was associated with lower odds of worsening pain and depressive symptoms with no difference in physical function.