title: Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic.
abstract: BACKGROUND
  Data are limited on the use and outcomes of urine drug tests (UDTs) among patients with advanced cancer. The main objective of this study was to determine the factors associated with UDT ordering and results in outpatients with advanced cancer.
  
  
  METHODS
  A retrospective chart review was conducted of 1058 patients who attended an outpatient supportive care clinic from March 2014 to November 2015. Sixty-one patients who were receiving chronic opioid therapy and underwent UDTs were identified. A control group of 120 patients who did not undergo UDTs was selected for comparison.
  
  
  RESULTS
  Sixty-one of 1058 patients (6%) underwent UDTs, and 33 of 61 patients (54%) had abnormal results. Multivariate analysis indicated that the odds ratio for UDT ordering was 3.9 in patients who had positive Cut Down, Annoyed, Guilty, and Eye Opener (CAGE) questionnaire results (P = .002), 4.41 in patients aged < 45 years (P < .001), 5.58 in patients who had moderate-to-severe pain (Edmonton Symptom Assessment Scale pain scores ≥4; P < .001), 0.27 in patients with advanced-stage cancer, (P = .008), and 0.25 in patients who had moderate-to-severe fatigue (P = .001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were prescribed opioids absent in urine (14 of 52 tests; 27%) and unprescribed opioids in urine (13 of 52 tests; 25%).
  
  
  CONCLUSIONS
  UDTs were used infrequently among outpatients with advanced cancer who were receiving chronic opioid therapy. Younger age, positive CAGE questionnaire results, early stage cancer or no evidence of disease status, higher pain intensity, and lower fatigue scores were significant predictors of UDT ordering. More than 50% of UDT results were abnormal. More research is necessary to better characterize aberrant opioid use in patients with advanced cancer. Cancer 2016;122:3732-9. © 2016 American Cancer Society.
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Joseph A
authors: http://orcid.org/0000-0002-9185-6108
authors: JA
authors: Arthur
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Tonya
authors: T
authors: Edwards
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Zhanni
authors: Z
authors: Lu
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Suresh
authors: S
authors: Reddy
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: David
authors: D
authors: Hui
authors: Department of Quantitative Sciences, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Jimin
authors: J
authors: Wu
authors: Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Diane
authors: D
authors: Liu
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Janet L
authors: JL
authors: Williams
authors: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
authors: Eduardo
authors: E
authors: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use* / Q000652:urine*; D000072716:Cancer Pain / Q000188:drug therapy* / Q000209:etiology / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000652:urine*; D010045:Outpatients; D012189:Retrospective Studies; D014556:Urine / Q000737:chemistry*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: aberrant; abuse; cancer; diversion; opioids; palliative care; urine drug test