OBJECTIVES

Determine factors associated with opioid receipt among adults with colorectal cancer (CRC) by age group.

METHODS

A retrospective cohort study derived from a 10% random sample of enrollees within IQVIA^TM Adjudicated Health Plan Claims Data from 2006-2015. The index date is the first CRC claim among individuals ≥18 years old continuously enrolled 12 months before and after the index. Opioid receipt was defined as any opioid prescription post-index. Baseline covariates were defined in the 12 months pre-index. A multivariable logistic model was used to examine the odds of opioid receipt, adjusting for pre-index opioid receipt, sex, comorbidities, and concomitant psychoactive medication use. A multivariable generalized linear model with a Gamma distribution and log-link was used to examine morphine equivalent daily dose (MEDD) post-index.

RESULTS

: Of 8,737 subjects, 54.90% received an opioid post-CRC with a median (IQR) MEDD of 15.0 (34.4). Compared to individuals 55 to 64 years, the odds of opioid receipt were higher but not statistically significant among individuals aged ≤35 years (odds ratio (OR) 1.02; 95% Confidence Interval (CI): 0.77-1.35), 35 to 44 years (OR 1.03; 95% CI: 0.87-1.21), and 45 to 54 years (OR 1.07, 95% CI: 0.96-1.19). The average marginal effect (AME) associated with age under 35 years was -5.10 MEDD (95% CI: -10.83- -0.63), 35 to 44 years (-5.81; 95% CI: -9.18- -2.44), and 45 to 54 years (-2.09; 95% CI: -3.97- -0.21).

CONCLUSIONS

: Opioid receipt did not differ between age groups post-index, yet the oldest age group was associated with a significantly higher MEDD. This finding is concerning as older adults are more sensitive to medications. Results indicate a need for clarification of determinants of opioid dose in this understudied population. Further research may specify how much of the observed associations are clinically justified versus potential age disparities in the treatment of pain in patients with CRC.