Evaluating the incidence and predictors of chronic opioid use in early survivorship for patients with diffuse large B-cell lymphoma

Background — Opioid exposure during cancer treatment is common and leads to new persistent opioid use (NPOU) in a subset of patients. There are limited data on the incidence and predictors of NPOU among patients with diffuse large B-cell lymphoma (DLBCL).

Methods — We conducted a population-based cohort study including patients with DLBCL ≥18 years old from Ontario, Canada who received first-line rituximab-based chemoimmunotherapy from 2014-2021 and survived >365 days after treatment. We defined opioid exposure as filling ≥1 opioid prescriptions between 90 days prior to and 180 days after first chemoimmunotherapy (index date). The primary outcome was NPOU defined as filling ≥1 opioid prescriptions within both 181-360 days and 361-545 days after index. We used a multivariable modified Poisson regression model to assess the relative risk (RR) of NPOU.

Results — Our cohort consisted of 4,988 patients with DLBCL with a median age of 66 years. Opioid exposure occurred in 55.0% of patients. 6.7% of patients fulfilled criteria for NPOU, including 10.4% of exposed patients compared to 2.4% of unexposed patients. In the multivariable analysis, exposed patients were four times more likely to develop NPOU (RR 3.79, 95% CI 2.85-5.06). Other predictors of NPOU included relapsed/refractory disease, palliative care utilization, prior mental health diagnoses, and high-dose vs. low-dose opioid exposure.

Conclusions — >1 in 2 DLBCL patients were exposed to opioids during treatment and 1 in 10 exposed patients developed NPOU. Our study identified several predictors of NPOU in DLBCL, which may enable clinicians to identify high-risk patients who would benefit from early intervention.