An assessment of provider specialties who prescribe opioids to older adult cancer survivors.

513 Background: Older post-treatment cancer survivors have concerning rates of unsafe opioid prescribing. Little is known about the specialty of providers prescribing to survivors, which is essential to guide interventions. Methods: Using SEER-Medicare data, we characterized the specialties of prescribers of opioids to cancer survivors after treatment completion. We included adults age > 65 diagnosed 2014-2017 with stage I-III female breast, lung, or colorectal cancer with ≥6 months treatment-free follow-up through 2019. Opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain medicine, or other. Prescribing patterns were summarized for each specialty and cancer. Generalized estimating equation models captured relative likelihood of an opioid being prescribed by a provider within each specialty compared to a primary care provider (PCP). Results: Among 36,716 breast, 16,658 colorectal, and 74,462 lung cancer survivors, 46% of breast, 49% of colorectal, and 49% of lung cancer survivors filled ≥1 opioid prescription during follow-up. For all three cancers, PCPs prescribed a greater share of opioid fills (50%-54%) than other specialists, prescribed opioids to a greater share of survivors (49%-56%) than other specialists, and prescribed opioids for longer durations (median 30 days/year) than oncologists and surgeons. (Table) The likelihood of an opioid being prescribed by an oncologist was up to 9 times lower than that of it being prescribed by a PCP: probability ratio [PR] 0.11 95% confidence interval [CI] (0.10-0.13) for breast, PR 0.12 (95% CI, 0.10-0.14) for colorectal, and PR 0.15 (95% CI, 0.13-0.17) for lung cancer survivors. Conclusions: PCPs are highly involved in prescribing opioids to older survivors of common cancers. Interventions to enhance pain management for cancer survivors, including opioid stewardship efforts, should target the primary care setting or focus on transitioning opioid management from oncology to primary care. Primary care Oncology Surgery Pain Other Percentage of fills prescribed by each provider specialty Breast 50.4 5.8 15.3 6.7 9.2 Colorectal 55.6 6.6 13.7 4.7 8.9 Lung 54.1 8.3 10.5 7.0 8.7 Percentage of survivors who had at least one opioid prescribed by a provider Breast 49.2 9.3 40.8 6.6 29.6 Colorectal 52.6 11.1 38.7 5.7 29.9 Lung 55.7 14.6 32.4 8.2 29.4 Median annual duration of opioids, days Breast 30 (10-80) 20 (7-50) 6 (4-12) 33 (15-120) 4 (3-6) Colorectal 30 (10-90) 20 (9-50) 6 (4-13) 30 (15-90) 4 (3-7) Lung 30 (10-90) 26 (10-55) 6 (4-13) 35 (16-110) 4 (3-7) Likelihood that an opioid was prescribed by a specialist compared to a primary care provider, PR (95% CI) Breast Ref. .11 (.10-.13) .30 (.29-.32)