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Observational Study
. 2023 Aug 22;31(9):531.
doi: 10.1007/s00520-023-07944-8.

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

Jun Han  1   2 , Martin Rolles  3   4 , Fatemeh Torabi  1 , Rowena Griffiths  1 , Stuart Bedston  1 , Ashley Akbari  1   2 , Bruce Burnett  1 , Jane Lyons  1 , Giles Greene  5 , Rebecca Thomas  6 , Tamsin Long  6 , Cathy Arnold  2   7 , Dyfed Wyn Huws  5 , Mark Lawler  2   8 , Ronan A Lyons  1   2
Affiliations
Observational Study

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

Jun Han et al. Support Care Cancer. .

Abstract

Purpose: Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care.

Methods: A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds.

Results: We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12-1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04-1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08-1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision.

Conclusions: We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients' demographic background.

Keywords: Analgesia; COVID-19 pandemic; Cancer; Pain; Prescription; Primary care.

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Conflict of interest statement

JH, FT, RG, SB, AA, BB, JL, GG, RT, TL, CA and DWH have nothing to declare. MR and RAL are members of the Welsh Government COVID-19 Technical Advisory Group. ML has received honoraria unrelated to this work from Bayer, Carnall Farrar, EMD Serono, Novartis, Pfizer and Roche.

Figures

Fig. 1
Fig. 1
Two patient cohorts and the analgesic prescription assessment periods for each cohort. WCISU, Welsh Cancer Intelligence & Surveillance Unit data; RCDD, Rapid Cancer Diagnosis Dataset (Wales); CaNISC, Cancer Network Information System Cymru; PEDW, Patients Episodes Dataset for Wales; OPDW, Outpatient Database for Wales; ADDE, Annual District Death Extract
Fig. 2
Fig. 2
Average number of analgesic prescriptions during the pre-pandemic period and the pandemic period (a) and percentage of patients with analgesic prescriptions during the first year after the date of cancer diagnosis (Cohort I) and over the 3 months prior to the date of death (Cohort II) (b). The shaded strips in b mark the transition from the pre-pandemic to the pandemic in 2020
Fig. 3
Fig. 3
WIMD quintile of the residence areas and average analgesic prescriptions. a Average number of opioid and antineuropathic prescriptions. b Average number of strong and weak opioid prescriptions. Assessment time for Cohort I patients: the first year after the date of diagnosis; assessment time for Cohort II patients: the last 3 months before date of death
Fig. 4
Fig. 4
WIMD quintile of the residence areas and proportion of patients with an analgesics prescription. a Percentage of patients with opioids and antineuropathics prescription. b Percentage of patients with strong and weak opioids prescription. Assessment time for Cohort I patients: the first year after the date of diagnosis; assessment time for Cohort II patients: the last 3 months before the date of death. The shaded strips mark the transition from the pre-pandemic to the pandemic in 2020
See this image and copyright information in PMC

References

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