OBJECTIVES: Describe patterns and predictors of opioid utilization among cancer survivors.

METHODS: A systematic literature review was conducted in July 2020 on PubMed/MEDLINE to assess the landscape of opioid use in cancer survivors. A broad search strategy of relevant terms was used: ("Cancer Survivors/classification"[Mesh] OR “cancer survivors” OR “patients with cancer”) AND ("Analgesics, Opioids/administration and dosage"[Mesh] OR "Analgesics, Opioids/adverse effects"[Mesh] OR "Analgesics, Opioids/classification"[Mesh] OR “Analgesics, Opioids/economics"[Mesh] OR "Analgesics, Opioids/organization and administration"[Mesh] OR "Analgesics, Opioids/poisoning"[Mesh] OR "Analgesics, Opioids/standards "[Mesh] OR "Analgesics, Opioids/therapeutic use"[Mesh] OR "Analgesics, Opioids/toxicity"[Mesh] OR “opioid use” OR “opioid prescribing”) AND Humans[Mesh] AND English[lang]. Articles were included if they assessed opioid utilization in cancer survivors and were excluded based on predetermined criteria, such as palliative care, cancer pain management, and opioid safety/efficacy/outcomes.

RESULTS: The search resulted in 82 articles. Backward snowballing and independent searches of key words identified 17 additional articles, for a total of 99 articles. Title and abstract screening according to inclusion and exclusion criteria resulted in 14 articles, all of which passed full-text screening by two independent reviewers. A considerable proportion (5-38%) of cancer survivors continue to utilize opioids long after cancer therapy is completed. Lung cancer survivors were more likely to be chronic opioid users, while colon cancer survivors had low persistent opioid use. Comorbid conditions such as pain, anxiety, depression, alcohol and tobacco use as well as cancer stage and prior opioid use increased risk of chronic opioid utilization.

CONCLUSIONS: Cancer survivors are at risk for sustained opioid use following cancer treatment, although this has not been comprehensively studied across cancer types and treatment modalities. Opioid use in several cancer types, including breast and head and neck, are better studied than others. Future studies are needed to identify underlying risk factors for persistent opioid use in cancer survivors.