Adjuvant Use and the Intensification of Pharmacologic Management for Pain in Nursing Home Residents with Cancer: Data from a US National Database

Shao Hsien Liu, University of Massachusetts Chan Medical School
Jacob N. Hunnicutt, VA Medical Center
Christine M. Ulbricht, University of Massachusetts Chan Medical School
Catherine E. Dubé, University of Massachusetts Chan Medical School
Anne L. Hume, The Warren Alpert Medical School
Kate L. Lapane, University of Massachusetts Chan Medical School


Objectives: Our objective was to describe the prevalence of adjuvants to opioid therapy and changes in these agents for pharmacologic management in nursing home residents with cancer. Methods: We included Medicare beneficiaries with cancer and documented opioid use at nursing home admission in 2011–2013 (N = 3268). The Minimum Data Set 3.0 provided information on sociodemographic and clinical characteristics. Part D claims provided information on opioid and adjuvant use during the 7 days after admission and 90 days later. Proportions of changes in these agents were estimated. Separate logistic models estimated associations between resident characteristics and (1) use of adjuvants at admission and (2) intensification of pharmacologic management at 90 days. Results: Nearly 20% of patients received adjuvants to opioids at admission, with gabapentin the most common adjuvant (34.4%). After 90 days, approximately 25% had maintained or intensified pharmacologic management. While advanced age (≥ 85 vs. 65–74 years, adjusted odds ratio [aOR] 0.80; 95% confidence interval [CI] 0.63–1.02) and comorbidities, including dementia (aOR 0.65; 95% CI 0.53–0.82) and depression (aOR 1.55; 95% CI 1.29–1.87), were associated with adjuvant use at admission, worse cognitive impairment (severe vs. no/mild, aOR 0.80; 95% CI 0.64–0.99) and presence of more severe pain (moderate/severe vs. no pain, aOR 1.60; 95% CI 1.26–2.03) were associated with intensification of drug regimen. Conclusion: Given aging-related changes and the presence of comorbid conditions in older adults, safety studies of these practices are warranted.