title: Opioid prescription after pain assessment: a population-based cohort of elderly patients with cancer.
abstract: OBJECTIVE
  The purpose of this study was to measure opioid prescription (OP) rates in elderly cancer outpatients around the time of assessment for pain and to evaluate factors associated with receiving OPs for those with severe pain.
  
  
  METHODS
  The cross-sectional cohort includes all patients with cancer in Ontario older than age 65 years who completed a pain assessment as part of a provincial initiative of systematic symptom screening. Patients were assigned to mutually exclusive categories by pain score severity: 0, 1 to 3 (mild), 4 to 6 (moderate), and 7 to 10 (severe). We linked multiple provincial health databases to examine the proportion of patients with an OP within 7 days after or 30 days before the assessment date. We examined factors associated with OPs for patients with pain scores of 7 to 10.
  
  
  RESULTS
  The proportion of patients with an OP increased as pain score severity increased: 10% of those with no pain, 24% of those with mild pain, 45% of those with moderate pain, and 67% of those with severe pain. More specifically, for those with severe pain, 41% filled an OP within 7 days of assessment for pain, and 26% had an OP from the 30 days before assessment for pain, leaving 33% without an OP. In multivariable analysis, factors associated with OPs are younger age, male sex, comorbid illness, cancer type, and assessment at home.
  
  
  CONCLUSIONS
  Despite a generous time window for capturing OPs, the proportion of patients without an OP seems high. Further knowledge translation is required to maximize the impact of the symptom screening initiative in Ontario and to optimize management of cancer-related pain.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. lisa.barbera@sunnybrook.ca
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.forename: Hsien
authors.initials: H
authors.lastname: Seow
authors.forename: Amna
authors.initials: A
authors.lastname: Husain
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Clare
authors.initials: C
authors.lastname: Atzema
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
authors.forename: Craig
authors.initials: C
authors.lastname: Earle
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.forename: Deborah
authors.initials: D
authors.lastname: Dudgeon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D016017:Odds Ratio; D009864:Ontario; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal