Opioid Shortages and Cancer; $15,000 Emesis; Palliative Rehab Boosts QoL

SAN DIEGO -- For patients with cancer, shortages of intravenous and other parenteral opioids led to lower rates of pain control, each hospitalization for nausea and vomiting cost roughly $15,000, and a palliative care program identifying one key problem helped improve quality of life (QoL).

Findings from the three studies will be presented here this week at the Palliative and Supportive Care in Oncology Symposium.

Dealing With Opioid Shortages

As routes of opioid administration changed during parenteral opioid shortages (POS), analgesia was initially worse for cancer patients in pain, a retrospective review of patient records found.

Pain control at first follow-up was achieved in 62% of patients during POS compared with 75% during a normal period (P=0.006), though rates were similar on second follow-up, according to Ali Haider, MD, of MD Anderson Cancer Center in Houston.

Before POS, use of parenteral opioids (IV breakthrough and patient-controlled analgesia) were 35% and 47% by the oncology and palliative care teams, respectively.

Unsurprisingly, these opioids were used less during shortages (18% and 29%, respectively) as the oncology and palliative care teams shifted to transdermal, extended release, and oral breakthrough opioids.

To conduct the study, the researchers reviewed records for 386 consecutive inpatient palliative care consultations a month prior to and after a February 2018 shortage announcement.

High Costs per Nausea/Vomiting Hospitalization

Among 5,000 hospitalized cancer patients, where nausea or vomiting was the primary reason, the median length of stay was 4 days and average total costs were $15,085, reported Eric Roeland, MD, of Massachusetts General Hospital in Boston.

Most cases appeared to be chemotherapy-induced -- with 45% having an insurance claim for a highly emetogenic chemotherapy within 30 days of hospitalization (65% looking at any chemotherapy).

While the average costs per hospitalization were significantly lower with Medicare ($12,111 versus $15,737 with private or other insurance, P<0.01) the vast majority of patients were not on Medicare (82%).

Roeland's group looked at insurance claims from 2011 to 2017 in a large U.S. database. Costs were similar regardless of tumor type (the six most common cancers were examined). The average patient age was 57.7 years, and most were women (67%).

The 5,293 hospitalizations represented 6.5% of all cases involving cancer patients with nausea and vomiting (n=80,995) and 0.6% of all hospitalizations for cancer patients in the database overall (n=918,192).

Palliative Rehabilitation Boosts QoL

A palliative care intervention started soon after diagnosis and focusing on a single item from the EORTC QLQ-C30 questionnaire helped address cancer patients' key problem of concern, a randomized study in Denmark found.

Among the 301 patients in the study, QoL scores favored those who had the intervention, for an absolute between-group difference of 3.0 (95% CI 0.0-6.0 P=0.047), which held up on sensitivity analyses (absolute difference of 3.3, 95% CI 1.0-5.6, P=0.005).

The program was rolled into a patient's regular oncologic treatment plan -- all of them had unresectable disease -- and scores of that specific QLQ-C30 scale were measured at 6 and 12 weeks, and then compared with baseline scores. Patients who did not receive the intervention were given usual palliative care.

Most had lung cancer (40%), followed by gastrointestinal (27%) and prostatic cancers (18%). The remaining had other types of solid tumors.