Evaluating the incidence and predictors of chronic opioid use in early survivorship for patients with diffuse large B-cell lymphoma.

Abstract

7087 Background: Exposure to opioids during cancer treatment is common and may lead to new persistent opioid use (NPOU) in a subset of patients in survivorship. There are limited data on the incidence and predictors of NPOU in a diffuse large B-cell lymphoma (DLBCL) cohort. Methods: We conducted a population-based cohort study utilizing health administrative datasets from Ontario, Canada. We included patients ≥18 years old with DLBCL who received first-line rituximab-based chemoimmunotherapy from 2014 to 2021 and survived >365 days after treatment. We considered patients to be opioid exposed if they filled ≥1 opioid prescriptions from 90 days prior to and 180 days after first rituximab-based chemoimmunotherapy (the exposure window). The primary outcome was NPOU defined as filling ≥1 opioid prescriptions in each of the two half-years of follow up after the exposure window (i.e. within both 0-180 days and 181-365 days). We used a multivariable Poisson regression model with robust error variance to assess the relative risk (RR) of NPOU while controlling for covariates. Results: Our cohort consisted of 4,988 patients with DLBCL. The median age was 66 years and 32.3% had relapsed/refractory disease. Opioid exposure occurred in 55.0% of the entire cohort. Of the entire cohort, 6.7% fulfilled criteria for NPOU including 10.4% of exposed patients compared to 2.4% of unexposed patients. In the multivariable analysis, exposed patients were four times more likely to develop NPOU (RR 3.81, 95% CI 2.85-5.07). After adjustment, other statistically significant predictors of NPOU included palliative care use in follow-up (RR 2.77, 95% CI 2.21-3.47), relapsed/refractory disease (RR 1.63, 95% CI 1.33-1.99), comorbid disease burden (RR 1.50, 95% CI 1.01-2.23), and prior mental health diagnoses (RR 1.27, CI 1.01-1.58). Conclusions: Over 1 in 2 DLBCL patients were exposed to opioids during treatment and 1 in 10 exposed patients developed NPOU. Exposed patients were four times more likely to develop NPOU. Our study identified several clinically relevant predictors of NPOU in DLBCL, which may enable clinicians to identify high-risk patients who would benefit from early intervention.