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Pain Medication Utilization Among Cancer Survivors: Findings From Medical Expenditure Panel Survey

Desai, Amarsinh M

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2018, PhD, University of Cincinnati, Pharmacy: Pharmaceutical Sciences/Biopharmaceutics.
Background: Cancer pain, either tumor-related or treatment-related, is common among cancer survivors. The objectives of this study were to 1) report recent trends in the pharmaceutical treatment of pain and HRQoL among cancer survivors; 2) to understand better the reasons for and the effects of pharmaceutical treatment of pain and 3) to assess relationship between pain medication use and workers’ productivity. Methods: This was a retrospective observational study using a nationally representative survey database. Cancer survivors, excluding survivors of non-melanoma skin cancer, were identified using survey questions and clinical classification codes. Utilization, cost and payer cost shares were obtained for following class of drugs such as non-opioids, opioids, narcotic analgesic combinations and adjuvants annually from 2008 to 2013. The demographic, geographical, clinical and economic predictor variables were regressed to assess their association with the total number of pain/opioid prescriptions. Productivity measures obtained from SF-12 and CSAQ were assessed for their association with pain/opioid medications use. Descriptive statistics were computed employing appropriate statistical procedures for the MEPS with its unique sampling design. Estimates were reported using zero-inflated Poisson regression. Results: Out of 23.4 million cancer survivors in 2008, 40.8% took pain medications; in 2013, 43.9% of 24.8 million survivors took pain medications; these percentages exceed those for patients without a history of cancer. The total number of prescriptions for pain medications increased from 60.3 million in 2008 to 74.3 million in 2013. The utilization of opioids and adjuvant analgesics was significantly (p<0.05) higher among the cancer survivors compared to individuals without cancer history. The cost (not adjusted for inflation) of pain medications increased from $3.5 billion in 2008 to $5.6 billion in 2013. Overall, the patient cost share decreased from 23.3% in 2008 to 17.0% in 2013. Stratified by opioid exposure the worst PCS and MCS scores were reported by opioid users. The odds of not receiving opioid medications was significantly (p<0.05) higher among elderly [age 65-74, OR= 2.73 (1.32 - 5.64)], minorities belonging to other race group [OR= 2.14 (1.03 - 4.43)], adjustment disorder [OR=3.41 (1.35 - 8.57)], more than one mental condition [OR=3.64 (1.51 - 8.76)]; from the count model significant (p<0.05) association was obtained for variables, experiencing high/severe pain [3.49 (2.09 - 5.84)], arthritis [1.93 (1.33 - 2.80)], more than one painful comorbidities [1.69 (1.12 - 2.55)], higher income [1.52 (1.09 - 2.11)], insurance status change over time [2.12 (1.41 - 3.16)]. Nearly, 54.0%-62.0% experienced little/no work limitation reported through SF-12 productivity measures. Among those who experienced no work limitation, significantly (p<0.05) higher proportion (73.0%) of respondents were non-users of pain medications. A higher proportion (75.0%) of post-treatment cancer survivors feels productive at work. Conclusion: This study reported substantial changes in treatment of cancer pain over-time. The economic impact of cancer survivorship is increasing with growing cancer population. The spending in terms of patient share decreased. Poor HRQoL scores were obtained stratified by opioid exposure. Many post-treatment cancer survivors were employed and remained productive.
Pamela Heaton, Ph.D. (Committee Chair)
Jill Boone, Pharm.D. (Committee Member)
Teresa Cavanaugh, Pharm.D. (Committee Member)
Christina Kelton, Ph.D. (Committee Member)
Alex Lin, Ph.D. (Committee Member)
221 p.

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Citations

  • Desai, A. M. (2018). Pain Medication Utilization Among Cancer Survivors: Findings From Medical Expenditure Panel Survey [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1535373082996854

    APA Style (7th edition)

  • Desai, Amarsinh. Pain Medication Utilization Among Cancer Survivors: Findings From Medical Expenditure Panel Survey. 2018. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1535373082996854.

    MLA Style (8th edition)

  • Desai, Amarsinh. "Pain Medication Utilization Among Cancer Survivors: Findings From Medical Expenditure Panel Survey." Doctoral dissertation, University of Cincinnati, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1535373082996854

    Chicago Manual of Style (17th edition)