Abstract C050: Impact of opioid prescriptions on survival among adults with advanced pancreatic cancer in Puerto Rico, 2012–2021

Background: Pancreatic cancer is one of the deadliest malignancies, with most patients in Puerto Rico (PR) presenting at advanced stages with a low survival rate. Emerging evidence suggests that opioids may be associated with increased survival in advanced cancer populations. This study aims to describe demographic and clinical characteristics of patients with advanced pancreatic cancer in PR and evaluate the effects of opioids on the risk of death. Methods: We conducted a retrospective cohort study using data from the PR Central Cancer Registry. Patients aged ≥18 years who survived ≥60 days after being diagnosed with stage III or IV pancreatic cancer from 2012 to 2021 were included, requiring continuous enrollment from diagnosis until death or opioid exposure. Opioid exposure was defined as receipt of either a 60-day continuous supply or two non-consecutive months of opioid prescriptions. Chi-square analysis was used in the descriptive analysis stratified by opioid-exposure. Additionally, Kaplan-Meier survival curves were used to estimate 18-month survival and compare median survival between opioid-exposed and unexposed groups. Multivariable logistic regression was used to examine the association between opioid use and multiple demographic and clinical factors. Similarly, multivariable Cox regression was used to estimate the hazard ratios to examine the association of opioid prescription and risk of death. Results: Among 601 patients in our cohort, 14.1% received opioids. Most were male (57.6%), aged ≥65 years (59.6%, median age: 66.6 years), insured by Medicare (39.4%), and underwent surgery, chemotherapy, or radiotherapy as first-course treatment (78.5%). Bivariate analysis showed that opioid exposure was significantly associated with age, health insurance type, and first-course treatment (p<0.05). Median survival was nearly two times greater in patients who received opioid prescriptions than those who did not (6.7 months vs 3.7 months, respectively). Logistic regression showed Medicaid patients had over three times the odds of receiving opioids than those with private insurance (OR: 3.7, 95% CI: 1.55–8.65). Patients aged ≥65 years had 78% lower odds than those <65 (OR: 0.22, 95% CI: 0.11–0.43). Those without first-course treatment had 76% lower odds than those treated (OR: 0.24, 95% CI: 0.10–0.59). Furthermore, the risk of death among patients without opioid prescriptions was 24% higher than patients with opioid prescriptions (HRadj: 1.24; 95% CI: 0.95-1.61); however, this was not significant (p-value >0.05). Conclusions: Opioid prescriptions remain the cornerstone of palliative care in managing moderate to severe malignant pain. Multiple organizations endorse prescriptions to improve comfort, functional performance, and quality of life. In our study, opioid use was associated with an increased median survival, while the decrease in the risk of death did not reach statistical significance. Further studies should continue to investigate how opioids may benefit survival and examine the underlying causes of disparities in access. Citation Format: Adam Cordle, Axel Gierbolini-Bermúdez, MA, DrPH, Tonatiuh Suárez-Ramos, MS, Marjorie Vazquez-Roldan, DrPH, Carlos R. Torres-Cintrón, MPH, María Ramos-Fernández, MD, Karen J. Ortiz-Ortiz, MA, MPH, DrPH. Impact of opioid prescriptions on survival among adults with advanced pancreatic cancer in Puerto Rico, 2012–2021 [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C050.