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Opioid and benzodiazepine use in gynecologic oncology patients
  1. Khrystyna Levytska1,
  2. Savannah R Pena1,
  3. Jubilee Brown2,
  4. Ziqing Yu3,
  5. Meghan K Wally3,
  6. Joseph R Hsu3,
  7. Rachel B Seymour3 and
  8. Wendel Naumann2
  9. PRIMUM Group
    1. 1 Obstetrics and Gynecology, Atrium Health, Charlotte, North Carolina, USA
    2. 2 Gynecologic Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
    3. 3 Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
    1. Correspondence to Dr Khrystyna Levytska, Obstetrics and Gynecology, Atrium Health, Charlotte NC 28203, North Carolina, USA; khrystyna.levytska{at}


    Objective The goals of this study were to describe opioid and benzodiazepine prescribing practices in the gynecologic oncology patient population and determine risks for opioid misuse in these patients.

    Methods Retrospective study of opioid and benzodiazepine prescriptions for patients treated for cervical, ovarian (including fallopian tube/primary peritoneal), and uterine cancers within a single healthcare system from January 2016 to August 2018.

    Results A total of 7643 prescriptions for opioids and/or benzodiazepines were dispensed to 3252 patients over 5754 prescribing encounters for cervical (n=2602, 34.1%), ovarian (n=2468, 32.3%), and uterine (n=2572, 33.7%) cancer. Prescriptions were most often written in an outpatient setting (51.0%) compared with inpatient discharge (25.8%). Cervical cancer patients were more likely to have received a prescription in an emergency department or from a pain/palliative care specialist (p=0.0001). Cervical cancer patients were least likely to have prescriptions associated with surgery (6.1%) compared with ovarian cancer (15.1%) or uterine cancer (22.9%) patients. The morphine milligram equivalents prescribed were higher for patients with cervical cancer (62.6) compared with patients with ovarian and uterine cancer (46.0 and 45.7, respectively) (p=0.0001). Risk factors for opioid misuse were present in 25% of patients studied; cervical cancer patients were more likely to have at least one risk factor present during a prescribing encounter (p=0.0001). Cervical cancer was associated with a higher number of risk factors (p<0.001).

    Conclusions Opioid and benzodiazepine prescribing patterns differ for cervical, ovarian, and uterine cancer patients. Gynecologic oncology patients are overall at low risk for opioid misuse; however, patients with cervical cancer are more likely to have risk factors present for opioid misuse.

    • Opioid-Related Disorders
    • Pain
    • Cancer Pain

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • Collaborators PRIMUM Group: Michael Beuhler, MD; Michael J Bosse, MD; Michael Gibbs, MD; Christopher Griggs, MD; Ashu Gulati, MS; Steven Jarrett, PharmD; Daniel Leas, MD; Susan Odum, PhD; Tamar Roomian, MS, MPH; Michael Runyon, MD; Animita Saha, MD; D Matthew Sullivan, MD; Brad Watling, MD.

    • Contributors KL, SRP: responsible for manuscript preparation, data collection, study design, and revisions. ZY, MW: responsible for study design, statistical analysis, and data compilation. SO, JRH, RS: contributed to the study design, statistical analysis, and data collection. JB, WN: contributed to study design and manuscript preparation. WN: guarantor. The PRIMUM group is a group of authors responsible for establishing the database used in the study for collecting opioid prescribing data.

    • Funding This work was supported in part by a cooperative agreement (CE14-004 Award Number CE002520) from the Centers for Disease Control and Prevention and by an internal grant from the Carolinas Trauma Network Research Center of Excellence.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.