Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship

Goodlev, Eric R.; DiScala, Sandra; Darnall, Beth D.; Hanson, Molly; Petok, Alison; Silverman, Michael A.

doi:10.1089/jpm.2019.0171

Cited by 21 publications

(11 citation statements)

References 67 publications

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“…drafted an interview guide with focused on interviewees' perspectives on and experiences managing chronic pain in cancer survivorship (ie, following completion of curative-intent cancer treatment). Interview guide questions (Data Supplement, online only) were informed by available guidance and models for managing chronic pain among cancer survivors 12,13 as well as prior studies. 14,15 Questions focused on clinicians' experiences caring for patients who used opioids during active treatment and continue to experience pain as they transition to survivorship, factors influencing decision-making related to chronic pain management, and communication with cancer survivors and other clinicians.…”

Section: Data Collectionmentioning

confidence: 99%

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

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Jones

Fish

et al. 2023

JCO Oncology Practice

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PURPOSE: Among cancer survivors who have completed curative-intent treatment, the high prevalence and adverse consequences of chronic pain are well documented. Yet, research on clinicians' experiences with and perspectives on managing chronic pain among cancer survivors is critically lacking. METHODS: We conducted semistructured interviews with 17 clinicians (six oncology, three palliative care, and eight primary care) affiliated with an academic medical center. Interview questions addressed clinicians' experiences with and perspectives on managing chronic pain (with or without opioid therapy) during the transition from active treatment to survivorship. A multidisciplinary team conducted content analysis of interview transcripts to identify and refine themes related to current practices and challenges in managing chronic pain in this context. RESULTS: Overall, clinicians perceived chronic pain to be relatively uncommon among cancer survivors. Identified challenges included a lack of clarity about which clinician (or clinicians) are best positioned to manage chronic pain among cancer survivors, and (relatedly) complexities introduced by long-term opioid management, with many clinicians describing this practice as outside their skill set. Additionally, although most clinicians recognized chronic pain as a biopsychosocial phenomenon, they described challenges with effectively managing psychosocial stressors, including difficulty accessing mental or behavioral health services for cancer survivors. CONCLUSION: Discovered challenges highlight unmet needs related to cancer survivor-clinician communication about chronic pain and the absence of a chronic pain management home for cancer survivors, including those requiring long-term opioid therapy. Research evaluating routine pain monitoring and accessible, tailored models of multimodal pain care in survivorship may help to address these challenges.

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Section: Data Collectionmentioning

confidence: 99%

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

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Jones

Fish

et al. 2023

JCO Oncology Practice

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“…Differences in opioid use over time and within subgroups of cancer patients highlight the importance of monitoring opioid use during a patient's cancer trajectory possibly used in combination with other strategies for pain management and reduction of misuse 20,36 . Research is needed within subgroups of cancer patients to differentiate overuse from appropriate use based on treatment and survivorship plans and patient goals.…”

Section: Discussionmentioning

confidence: 99%

“…Pain management is integral to cancer care, 16,17 however, opioid dose limits in clinical practice guidelines for non‐cancer pain have been misapplied to cancer and palliative care patients 7‐9 . Efforts to manage opioid misuse may have unintended consequences including complex pain and inadequate pain relief through diagnosis, treatment, and survivorship 18‐20 . Possibly illustrating this point, a Canadian study found no change in opioid prescribing over time among older cancer patients while opioid prescribing increased among non‐cancer patients 21 .…”

Section: Introductionmentioning

confidence: 99%

Opioid use by cancer status and time since diagnosis among older adults enrolled in the Prostate, Lung, Colorectal, and Ovarian screening trial in the United States

2021

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Background Dosing limits in opioid clinical practice guidelines in the United States are likely misapplied to cancer patients, however, opioid use may be difficult to ascertain as they are largely excluded from opioid use studies. Methods The primary objective was to determine whether cancer patients were more likely to be chronic opioid users after diagnosis. We described prescription opioid use among U.S. older adult cancer patients during two time periods, within 2 years of diagnosis (short‐term) and at least 2 years beyond diagnosis (long‐term), compared to those without cancer (controls). Among participants in the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial with linkages to Medicare Part D data during 2011–2015, we used multivariable logistic regression to estimate the association between cancer diagnosis and opioid use outcomes controlling for demographics. The primary outcome of opioid use was measured with the following metrics: Any opioid use, chronic use (90 consecutive days supply of opioid use while allowing for a 7‐day gap between refills), high use (average daily morphine equivalent (MME) ≥120 mg for any 90‐day period), and total MME dose above 2,000 mg (MME2000). Results The short‐term cohort included 1,491 cancer patients and 24,930 controls. Any use in the 2‐year post‐diagnosis period was higher among cancer patients OR 3.3 (95% CI: 3.0–3.7). Chronic use rates were similar by cancer status (4.6% vs. 3.8% for cases and controls, respectively). The long‐term cohort included 4,377 cancer patients and 27,545 controls. Rates of any use were similar among cancer patients and controls (63% vs. 59%). Conclusions Any opioid use was similar among long‐term cancer survivors compared to controls, but differed among short‐term survivors for any opioid use and marginally for chronic opioid use.

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“…Palliative care should take a holistic approach to pain management and provide interdisciplinary care that balances analgesia and appropriate opioid use in the early stage of cancer treatment. 23 , 24 Our interdisciplinary team (six physicians, two nurses, and two pharmacists) is working hard to improve this, and the number of the patients was small. Nevertheless, we supported the patients vigorously and continuously.…”

Section: Discussionmentioning

confidence: 99%

How Do We Taper and Discontinue Opioids in Cancer Patients? Considerations from the Activities of a Palliative Care Team at a University Hospital

Kihara

Shimada

Tsuneto

2021

Palliative Medicine Reports

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Background: The more the cancer treatments progress, the more the needs increase to taper and discontinue opioids in cancer patients. Furthermore, opioid dependence of cancer survivors has become a bigger problem. However, a safe opioid tapering and discontinuation method has not yet been established in cancer patients. Objective: To suggest a safe opioid tapering and discontinuation method in cancer patients. Design: We reviewed opioid type, dose, administration route, administration duration, reason for tapering and discontinuation, and presence/absence of opioid withdrawal symptoms in cancer patients whose opioids needed to be tapered and discontinued. Setting/Subjects: We recruited cancer patients referred to the palliative care team of Kyoto University Hospital-Japan whose opioids were tapered and discontinued. Measurements: Opioid withdrawal symptoms were assessed by two physicians, one nurse, and one pharmacist of palliative care team. Results: Opioids were tapered and discontinued in 25 out of 145 cancer patients (17%). Opioid withdrawal symptoms were observed in 3 of the 25 cases (12%). In withdrawal symptom cases and nonwithdrawal symptom cases, the mean maximum oral morphine-equivalent doses of opioids were 352.0 and 55.7 mg/day, and the mean administration duration of opioid were 82.3 and 28.7 days, respectively. Withdrawal symptoms occurred in patients receiving higher-dose opioids with longer administration duration and their symptoms tended to appear at approximately 10% of the maximum dose. Conclusions: We suggest that withdrawal symptoms may be prevented by using a two-stage method rather than a monotonous tapering method in cancer patients whose higher-dose opioid with longer administration duration needed to be tapered and discontinued.

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Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship

Cited by 21 publications

References 67 publications

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

Opioid use by cancer status and time since diagnosis among older adults enrolled in the Prostate, Lung, Colorectal, and Ovarian screening trial in the United States

How Do We Taper and Discontinue Opioids in Cancer Patients? Considerations from the Activities of a Palliative Care Team at a University Hospital

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