Pain, palliation, and opioid use patterns: A nationwide analysis of neoplasm-related pain admissions and trends (2016-2020).

Rajvi Gor Jacobi Medical Center, Albert Einstein Medical Center, Bronx, NY info_outline Rajvi Gor, Pranav Gwalani, DHAIRYA GOR, Anand Shah, Rahul Kumar Thakur, Abhishek Kumar

Authors Rajvi Gor Jacobi Medical Center, Albert Einstein Medical Center, Bronx, NY info_outline Rajvi Gor, Pranav Gwalani, DHAIRYA GOR, Anand Shah, Rahul Kumar Thakur, Abhishek Kumar Organizations Jacobi Medical Center, Albert Einstein Medical Center, Bronx, NY, Icahn School of Medicine at Mount Sinai, New York, NY, Henry Ford Hospital, Detroit, MI, Rutgers NJMS, Newark, NJ, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, Department of Hematology and Oncology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY Abstract Disclosures Research Funding No funding sources reported Background: Neoplasm-related pain (NRP) remains a significant contributor to the diminished quality of life in cancer patients. We aimed to study the epidemiological characteristics and trends among patients hospitalized for NRP from 2016 to 2020. Methods: A retrospective study of patients hospitalized for primary or secondary diagnosis of NRP from 2016-2020 was conducted using the National Inpatient Sample (NIS) database. Temporal trends in the prevalence, mortality rate (MR), length of stay (LOS), hospitalization cost, palliative care consults, and opioid use/dependence/abuse (OUD) were assessed using linear regression or the Cochran-Armitage test. Further, the NIS database was searched to identify all patients admitted with a diagnosis of OUD. Amongst them, the proportion of patients with a coexisting diagnosis of NRP was calculated. Analysis was done using R 4.3.2 and SAS 9.4. Results: 174,530 cases with NRP were identified from 2016-2020, with a median age at hospitalization of 61(IQR: 52,70). The number of hospitalizations increased from 28,036 in 2016 to 41,013 in 2019 and then dropped to 38,040 in 2020 (p < 0.001). The total inpatient MR was 7.8%, decreasing from 8.5 % in 2017 to 7.0% in 2020 (p < 0.0001). The mean cost of hospitalization increased significantly from $64,162.5 in 2016 to $82,943.8 in 2020 (p < 0.001). There was no significant change in the mean LOS. The number of palliative care consults increased from 29.8% in 2016 to 31.5% in 2019 and then dropped to 31.3% in 2020 (p < 0.001). Among 174,530 NRP patients, 5,844 (3.4%) had a coexisting diagnosis of OUD, which increased from 832 (3.0%) in 2016 to 1419 (3.7%) in 2020 (p < 0.001). A total of 737,971 patients with a diagnosis of OUD were admitted from 2016-2020, of which 5844 (0.79%) had a coexisting diagnosis of NRP. Conclusions: We observed increased hospitalizations for NRP and related palliative care consults from 2016 to 2019, with a subsequent decline in 2020. This drop could be related to the impact of the COVID-19 pandemic. Despite the rise in the cost of hospitalizations, there has been a declining trend in MR, potentially due to improved quality of care. The gradual rise in the coexistence of OUD among NRP patients is notable. Yet, NRP patients remain a minority within the broader context of OUD-related admissions, underscoring the need for nuanced, patient-centered approaches in NRP management. 2016 2017 2018 2019 2020 p-value Prevalence (%) 28,036 (16.1) 31,797 (18.2) 35,644 (20.4) 41,013 (23.5) 38,040 (21.8) < 0.001 MR 2284 (8.2) 2709 (8.5) 2767 (7.8) 3292 (8.0) 2647 (7.0) < 0.001 Mean LOS (SD) 7.3 (8) 7.2 (8) 7.3 (8.3) 7.4 (8.7) 7.3 (8.2) 0.2905 Charges, USD (SD) 64162.4 (93789.9) 67845.2 (102664.3) 72281.0 (111169.0) 77100.1 (122042.7) 82943.76 (126484.9) < 0.001 Palliative care consult (%) 8356 (29.8) 9863 (31.0) 11057 (31.0) 12908 (31.5) 11922 (31.3) < 0.001 OUD (%) 832 (3.0) 1018 (3.2) 1163 (3.3) 1412 (3.4) 1419 (3.7) < 0.001

Pre-clinical