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. 2025 Apr 6;18(4):536.
doi: 10.3390/ph18040536.

Hospitalized Cancer Patients with Opioid Management for Chemo-Induced Ulcerative Mucositis Lessens the Patients' Overall Burden of Illness

Minu Ponnamma Mohan  1 , Joel B Epstein  2 , Kapil S Meleveedu  3 , Parikshit Padhi  4 , Roberto Pili  5 , Poolakkad S Satheeshkumar  5
Affiliations

Hospitalized Cancer Patients with Opioid Management for Chemo-Induced Ulcerative Mucositis Lessens the Patients' Overall Burden of Illness

Minu Ponnamma Mohan et al. Pharmaceuticals (Basel). .

Abstract

Objectives: Mucositis is a debilitating side effect of cancer therapy that adversely affects quality of life, cost of care, and the outcome of cancer therapy. Oral mucositis-related pain may be treated with numerous modalities but often includes opioids. The effects of opiate treatment on painful UM and its overall influence on the burden of illness (BOI) in cancer patients remain unknown. Methods: This study utilized the 2017 United States (US) National Inpatient Sample (NIS) database. The exposure was opioid treatment for chemo-induced ulcerative mucositis (UM), oral mucositis-induced pain, and the main outcomes included in-hospital mortality and BOI, length of hospital stays (LOS), and total hospital charges. Multivariable regression analysis was used to examine the relationship between outcomes and the key independent variable, opioid use, adjusting for propensity scores. Results: In the propensity score-adjusted analysis, UM patients with opioid treatment had 0.51 times lower total charges (95% CI: 0.42-0.76) and 0.67 times shorter LOS (95% CI: 0.51-0.87) than the UM patients without opioid treatment. However, there was no association between opioid treatment and in-hospital mortality. In the sensitivity analysis, the effect estimates were comparable in the propensity score-adjusted analysis, the decile-adjusted model, and the full model with the non-propensity score estimated method. Conclusions: Cancer patients with chemotherapy-induced UM-prescribed opioid analgesics for treating pain are associated with a lower BOI. Opioid pain medications are commonly provided to cancer survivors; estimating the BOI among them is crucial in supportive care research.

Keywords: burden of illness; chemotherapy; in-hospital mortality; opioid; oral mucositis; propensity score estimation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The plot of missing data patterns.
Figure 2
Figure 2
(a) The box–whiskers plot of the propensity score in the single dataset. (b) The box–whiskers plot of the propensity score in the partitioned dataset (five imputed datasets) for validation assessment.
Figure 3
Figure 3
(a) The Kernel density plot of the propensity score in the single dataset. (b) The Kernel density plot of the propensity score from five imputed datasets.
Figure 4
Figure 4
Covariate balance: the degree to which the distribution of covariates is similar across degrees of treatment is referred to as covariate balance. All measured variables were balanced between the groups.
Figure 5
Figure 5
The maximum standardized mean differences between treatment (opioids) and non-treatment (non-opioids).
See this image and copyright information in PMC

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