Department of Research & Evaluation News

Young cancer survivors were more likely to be on long-term opioid therapy when compared to their counterparts without cancer. But among those on long-term opioid therapy, young cancer survivors were less likely to develop opioid use disorder than their peers without cancer, according to Kaiser Permanente research.

The study was published in Cancer in May 2025.

“We know we have an opioid epidemic in the United States and we also know that opioids are used to manage cancer pain,” said the study’s lead author Chun R. Chao,  PhD, MS, of the Kaiser Permanente Southern California Department of Research & Evaluation. “However, we did not have a good picture of the risks and benefits of long-term opioid therapy among cancer survivors, especially for young people who have survived cancer.”

Researcher focuses on cancer in youth

A cancer epidemiologist, Dr. Chao focuses her research on cancer’s effect on young people. In this study, she and the research team looked adolescents and young adults — ages 15 to 39 — who were diagnosed with cancer and survived at least 2 years at Kaiser Permanente Southern California between 2000 and 2012. The patients’ records were then followed electronically through 2019. These adolescent and young adult (AYA) cancer survivors were compared to matched peers without a history of cancer.

The study found:

• 2% of AYA cancer survivors had long-term opioid use during follow-up, compared with 1.8% of those without cancer.
• Cancer survivors had a higher risk for long-term high-dose opioid use and benzodiazepine co-use (which was evaluated because it predicted risk of overdose), compared with people who had not had cancer.
  • Benzodiazepines are drugs often prescribed to treat conditions such as anxiety disorders, insomnia, or seizures.
• Opioid overdose events were rare in the AYA cancer survivor population.
• Among those on long-term opioid therapy, cancer survivors had a lower risk of opioid use disorder or overdose compared with the general population.
  • The authors suggested that this finding could reflect the positive impact of cancer-related supportive services at Kaiser Permanente, including potential protective mechanisms such as more intensive clinical oversight, better support systems, or use of palliative care. The finding could also be due to under-diagnosis or under coding.

Chronic pain can be common with cancer

Chronic pain due to cancer and its treatments is a common complication among cancer survivors. Prescription opioids are often used for cancer pain management. However, the use, benefits, and harms of opioid use among cancer survivors transitioning out of acute treatment are not well understood, as cancer survivors have often been excluded from previous evaluations.

While there are broadly accepted guidelines for prescribing opioids, none currently address the specific considerations for opioid management among AYA cancer patients and survivors, said study co-author, Dov M. Shalman, MD, a physician in the Kaiser Permanente Los Angeles Medical Center’s Department of Geriatric, Palliative, and Continuing Care.

Young cancer survivors have unique concerns

“These young cancer survivors have unique medical and psychosocial concerns that impact their pain management needs,” Dr. Shalman said. “Many have been balancing complex cancer treatments while still in school or early in their career, and they may have young children of their own. Clearly clinicians can benefit from additional guidance on how best to care for these AYA patients.

“This research represents an important first step of identifying key trends and risk factors that distinguish this population from their peers.”

Other authors on this research include Hui Zhou, PhD; Katherine J. Pak, MS; Zheng Gu, MS; and senior author, Rulin C. Hechter, MD, PhD, of the Department of Research & Evaluation; Saro Armenian, MD, City of Hope, Duarte, Calif.; and Lanfang Xu, MS, MedHealth Statistical Consulting Inc, Sugar Land, Texas.