Opioid Therapy Overuse in Cancer Survivors: Cost-Inefficient, Poor Health Outcomes | AMCP Nexus 2025

Opioid therapy overuse in disease-free cancer survivors is cost inefficient and negatively impacts quality-adjusted life years (QALYs), when compared to rapid low-dose discontinuation of opioid therapy in cancer survivors, according to an abstract presented this week at the 2025 Academy of Managed Care Pharmacy (AMCP) Nexus Conference.

The abstract, titled ‘Cost-inefficiency of high-dose opioids therapy in disease-free cancer survivors: A real-world, US payer-perspective decision-tree analysis,’ was led by Albert Truong, Pharm.D., from Virginia Commonwealth University, Vasco Pontinha Ph.D., and David Holdford, Ph.D., both from the Virginia Commonwealth University School of Pharmacy.

The researchers found that opioid overuse cost $41,072, while rapid low-dose discontinuation cost only $34,223. Higher dose therapy is also associated with fewer quality adjusted life years, (1.1 vs 1.3, respectively).

They designed this study using longitudinal opioid exposure data obtained from a retrospective observational study of 610 disease free survivors treated at VCU Massey Comprehensive Cancer Center, while model inputs for opioid use disorder, mortality and costs were obtained from published peer-reviewed literature andpublic data.

Pain is one of the main symptoms of cancer and cancer treatment. One analysis revealed pain was reported by 59% of patients undergoing treatment, 64% of patients with advanced disease and in 33% of patients after treatment.

Advances in cancer diagnosis and treatment mean that cancer patients are living longer. During treatment, cancer patients are often prescribed opioids to deal with pain. However, this can lead to opioid use disorder if patients are continuedly prescribed opioids.

Other research shows that many cancer survivors continue their opioid therapy after treatment at progressively higher doses. For example, in a study of approximately 14,347 breast cancer survivors, 16% developed persistent opioid use. Compared with breast cancer survivors who did not develop opioid use disorder, women who did were more likely to be older (52.3% vs 42.5%), of White race (66.1% vs 51.3%), be obese (48.4% vs 42.6%) with a history of substance use disorders (13.0% vs 3.6%).

The Centers for Disease Control and Prevention has guidelines for prescribing opioids for pain, but does not include cancer-related pain. Other guidelines such as National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology recommend that physicians monitor patients for signs of addiction.

“Scenarios where opioid dose reduction may be considered include the patient rarely or never needing breakthrough analgesics, completion of an acute pain event, improvement of pain control through use of nonopioid or interventional pain management therapies, or well-controlled pain in the setting of stable disease. In these situations, the dose of opioid may be reduced by 10% to 20% after which the adequacy of pain control may be reevaluated and further dose reductions may be considered if appropriate,” the guidelines state. However, they do not touch on the economic impact of continued opioid use in cancer-free patients.

“Studies examining the economic inefficiency of increased opioid exposure in cancer survivors are, to our knowledge, non-existent,” the authors write in the abstract. “Absent explicit clinical guidelines for tapering, opioid stewardship strategies for dose minimization in long-term survivorship care are critical for avoiding negative outcomes and preventing added costs.”

AMCP Nexus 2025 is held from Oct. 27 to Oct. 30 in in National Harbor, MD.