P-485: Novel Observation of the Negative Effects of Persistent Chronic Opioid Use on Myeloma Survival: A Retrospective Urban-Based Cohort Study and Ongoing Prospective HealthTree Survey Study

Introduction: Overuse of opioids has been associated with a significant public health crisis, yet these drugs remain critical as adjunctive treatment for pain in multiple myeloma (MM). Prolonged survival with the use of autologous stem cell transplant (ASCT) and maintenance therapy validates the need to examine chronic opioid use (COU) patterns and the effects of COU on clinical outcomes.

Methods: A retrospective cohort study of MM patients (n=174) who received ASCT at an urban inner-city transplant center treating mostly Black patients was undertaken. Given the findings of this study, in collaboration with HealthTree Foundation, through a prospective survey-based study, we sought to identify other predictors of COU and gain insight into patient attitudes towards opioids. COU was defined as an active prescription for 3 consecutive months and daily opioid doses were converted to MME.

Results: At baseline, COU was observed in 92 (52.9%) patients, 27 (29.3%) of whom did not have a history of bone disease. Baseline average MME was 65.3 mg (SD=69.97 mg). COU rates and average MME/day were similar between those with and without bone disease. Previous illicit drug use was associated with higher baseline COU, while use of non-opioid analgesics, being retired, or employed were associated with lower baseline COU. 142 (81.6%) patients received opioids during ASCT, while 105 (60.3%) were discharged on opioids and 72 (41.4%) met criteria for COU at 6 months. In the 105 patients discharged on opioids, COU remained high over time, with 63 (60%) having COU at 6 months after ASCT. In baseline non-opioid users, 30 (36.6%) patients became new opioid users on discharge. Opioid use at hospital discharge was associated with a higher 6-month COU (p=0.008). Median OS in patients with 6-month COU was 48 months vs not reached (p=0.004; Fig 1). 6-month COU independently predicted for worse OS (p=0.006). Given these findings, we developed a 36-item survey addressing demographics like race and SES, disease markers, and experience with pain, use of opioids, opioid risk, and barriers to patient-provider communication. The survey is hosted on the HealthTree Cure Hub (healthtree.org). Between May 15th when the survey went live to May 24th, 230 patients have participated. Surveys will remain open for 3 months with an expected accrual of up to 750 patients. Descriptive data and association between baseline patient/disease-related characteristics and survey answers will be analyzed.

Conclusions: Here we describe high rates of baseline COU in MM unrelated to the presence of bone disease and highlight a high rate of opiate use after ASCT including a number of new users post-ASCT, which result in ongoing COU at 6 months. We demonstrate a negative impact of COU at 6 months on OS but not on PFS suggesting that opioid-related morbidity may play a role. These data highlight the need to improve our understanding and management of pain in MM. Results from our prospective HealthTree survey study will be presented at the Congress.