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  • br Table br Study characteristics by

    2020-08-14


    Table 1
    Study characteristics by Long-term NSAID Use.
    Study characteristics No Long-term Long-term p-value
    Race/ Ethnicity¶
    Insurance type
    Median Household Income
    Hospital Region
    Opioid Abuse
    Died
    Opioid Use
    Cancer Related Pain
    Long-term Use of Steroids,
    Immunotherapy
    Depression
    Anxiety
    Psychosocial stress
    Past Surgical History
    Non-Cancer Related Pain
    Other Substance Abuse
    substance Abuse
    Dependent Other substance 8.16 9.4
    Abuse
    Mean (Standard Error of Mean in parenthesis) ¶ Categorical variables reported as percentage
    Table 2A
    Crude and Adjusted Odds Ratios for Opioid Abuse among hospitalized patients with Breast cancer.
    Effect cORa aORb (aOR 95% CI) aOR pvalue
    or Immunotherapy
    Hospital Region
    Abuse
    Abuse
    a cOR Crude Odds Ratio
    b aOR Adjusted Odds Ratio
    compared to patients without dependent substance abuse. Similarly, odds of abuse were higher among subjects with non-dependent non-opioid substance abuse (aOR 2.33; 95% CI [1.9–2.87]) compared to subjects without a history of non-dependent non-opioid substance abuse. In addition, significantly higher odds were found among patients with depression, anxiety disorder, and psychosocial stress. The odds of opioid abuse were not statistically different between the levels of past surgical history.
    Association between long-term NSAID use and inpatient mortality
    No significant association with inpatient mortality was found among patients with a diagnosis of opioid abuse, anxiety disorder, and psychosocial stress; however, the odds of mortality were increased for depression.
    Table 2B
    Crude and Adjusted Odds Ratios for Inpatient mortality among Hospitalized patients with Breast cancer.
    Effect cORa aORb (aOR
    aOR p value
    Chemotherapy or
    Immunotherapy
    Hospital Region
    Abuse
    Abuse
    a cOR Crude Odds Ratio
    b aOR Adjusted Odds Ratio
    Association between long-term NSAID use and LOS
    Discussion
    Our study highlights the benefits of long-term NSAID use with re-spect to opioid abuse and adds to the limited number of studies  Cancer Treatment and Research Communications 21 (2019) 100156
    Table 2C
    Mean, crude and adjusted mean ratios for length of stay among hospitalized patients with breast cancer.
    Effect Mean cMR aMR (95% CI) P value
    Long-term current NSAID use 7.12
    use
    cMR Crude Mean Ratio.
    aMR Adjusted Mean Ratio.
    exploring this EIPA relationship among hospitalized patients with breast cancer. Our findings suggest that long-term NSAID use is protective against opioid abuse. Even after adjusting for several covariates, this association remained significant. In addition, we found similar asso-ciations between long-term NSAID use and hospitalization outcomes such as inpatient mortality and LOS.
    The anti-neoplastic [30] and neuroprotective effects [31,32] of NSAIDs as described in previous studies, may provide a biologically plausible and mechanistic explanation of the observed protective effect of NSAID use on opioid abuse risk. However, additional processes currently un-identified may be involved, warranting further studies to better understand this association as well as optimal dosing and dura-tion in this population.
    Compared to patients who were not on long-term NSAID use, those with a history of long-term NSAID use had lower inpatient mortality. This is not surprising as studies have documented improved cardio-vascular risk factors among patients who were placed on long-term NSAIDs such as aspirin, and prognostic indices and survival in cancers including breast cancer, colorectal cancer and lung cancer [12,14,33,34]. A possible explanation could be linked to the fact that since pain suppresses immunity, and immunity is vital for protecting against cancer, pain relief would lead to improved survival [35,36]. Another possible explanation is that NSAIDs have antineoplastic prop-erties through their inhibition of cyclooxygenase-2 enzyme (COX-2); there is evidence of an inverse relationship between COX-2 expression and tumor metastases [37].
    We found that long-term NSAID use was associated with a shorter LOS. Our findings are consistent with other studies, which suggest that cancer-related pain (usually associated with advanced metastatic dis-ease especially to the bone) increases the likelihood of patient referral for specialist treatments such as radiotherapy [35,38].
    This study has several important limitations which directly relate to the data available in the NIS database. First, the NIS database employs ICD-9 codes, which makes it impossible to determine the source of the opioid abuse, in addition to the potential for misreporting of opioid use resulting from the variations in code accuracy across hospitals and state. Second, we cannot rule out residual confounding from un-measured covariates such as characteristics of the breast tumor, dura-tion of opioid use and type of opioid. However, we carried out a robust methodological analysis and adjusted for comorbidity indices, previous chemotherapy and radiotherapy, the presence of cancer and non-cancer related pain. In addition, using breast cancer-specific hospitalization, our findings may not be generalizable to patients with other forms of cancer pain. Despite these limitations, the strength of the study lies in the inclusion of a large number of hospitalizations from a large socio-demographic pool, addressing pertinent issues in pain management and