To characterize risk factors associated with the chronic utilization of narcotics following treatment for penile cancer using a national insurance database.

The MarketScan Commercial Claims (MCCD) and Medicare supplemental databases (MSD) (2009-2023) were utilized to identify opioid-naive (no narcotic use within 3 months) adults who had undergone treatment for penile cancer. Our primary outcome of chronic opioid use was defined as prescriptions filled 3-6 months after initial treatment. Multivariable regression was utilized to identify independent predictors of chronic opioid use.

About 1286 patients (865 MCCD; 421 MSD) were identified, with 9.6% demonstrating chronic opioid use. In the MCCD cohort, history of mental health diagnosis (OR 2.82), fourth quartile initial prescription dose (OR 2.40), and partial penectomy (OR 2.58) were associated with chronic use ( P < .05). While in the MSD cohort third quartile initial prescription dose (OR 3.91), and radical penectomy (OR 3.68) were significant predictors ( P < .05).

Roughly 1 in 10 penile cancer patients will utilize narcotics after the acute/sub-acute procedural period. Initial prescription dose, history of mental health diagnosis, and more invasive surgical procedure appear to predict long-term use. This study is the first of its kind within this specific cohort, and underscores the importance of ongoing opioid stewardship, and assessment of this vulnerable population.