OBJECTIVES : Improvements in cancer therapy have led to an increase in the aggregate number of cancer survivors and duration of time spent in survivorship period along with new and continued opioid use. New persistent opioid use (NPOU; opioid naïve before cancer therapy, but fill opioid prescriptions beyond curative intent radiation (CIR)) as well as continued chronic opioid use (COU; filled opioid prescriptions before cancer therapy and continued to be prescribed opioids beyond CIR) is of increasing concern. Neither the extent to which cancer survivors who receive CIR develop NPOU or COU, nor factors that put them at risk for developing NPOU or COU, are known.

METHODS : Electronic medical record clinical and prescribing data from cancer survivors receiving CIR from a single academic cancer center from January 1, 2008 through December 31, 2018 were utilized. Associations of clinical and sociodemographic variables on NPOU and COU were assessed by bivariate analysis and multivariable binary logistic regression. Subgroup and sensitivity analyses were conducted.

RESULTS : Of patients that received CIR,19.7% developed NPOU and 54.8% continued COU. Head and neck cancer (OR 3.90, 95% CI, 2.59-5.86), stage 3 disease (OR 1.75, 95% CI, 1.01-3.05), additional chemotherapy (OR 1.58, 95% CI, 1.21-1.98), African American race (OR 1.38, 95% CI, 1.11-1.71), certain insurance types, various comorbid conditions, other opioid use (OR 3.05, 95% CI, 1.02-9.13), and nicotine use (OR 1.51, 95% CI, 1.21-2.08) conferred increased odds of NPOU. Indigent provided health insurance (OR 2.39, 95% CI, 1.00-5.73), certain comorbid conditions, and nicotine use (OR 2.60, 95% CI, 1.46-4.64) were associated with increased odds of COU.

CONCLUSIONS : Roughly one in five cancer survivors developed NPOU and more than half of patients continued COU. Patients with head and neck cancers may be at highest risk of NPOU, but other cancers, and socioeconomic and health differences also carry significant risk.