Outcomes of a Specialized Interdisciplinary Approach for Patients with Cancer with Aberrant Opioid-Related Behavior

Arthur, Joseph; Edwards, Tonya; Reddy, Suresh; Nguyen, Kristy; Hui, David; Yennurajalingam, Sriram; Park, Minjeong; Liu, Diane; Bruera, Éduardo

doi:10.1634/theoncologist.2017-0248

Cited by 54 publications

(64 citation statements)

References 49 publications

(54 reference statements)

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“…Although this interprofessional approach is particularly useful in addressing intense care needs at the end of life, it is also appropriate for patients earlier in the disease trajectory. For example, an interdisciplinary intervention may be particularly helpful to support patients with cancer who are at risk of opioid misuse . This teamwork may also help to reduce burnout among palliative care clinicians, which represents an area for future research.…”

Section: Defining Key Elements Of Palliative Care Delivery: Team‐basementioning

confidence: 99%

“…For example, an interdisciplinary intervention may be particularly helpful to support patients with cancer who are at risk of opioid misuse. 56 This teamwork may also help to reduce burnout among palliative care clinicians, which represents an area for future research. An international Delphi study in 2015 reached consensus that, at a minimum, interdisciplinary teams should consist of a physician, nurse, and psychosocial team member.…”

Section: What Is the Right Service Model? The Role Of Team-based Pallmentioning

confidence: 99%

See 1 more Smart Citation

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

Self Cite

275

252

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Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-science review directed at the practicing cancer clinician, we will first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. We will then provide conceptual models to support team-based, timely and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multi-dimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventative care to minimize crises at the end-of-life. Targeted palliative care involves identifying patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, we will summarize the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time.

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Section: Defining Key Elements Of Palliative Care Delivery: Team‐basementioning

confidence: 99%

Section: What Is the Right Service Model? The Role Of Team-based Pallmentioning

confidence: 99%

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

Self Cite

275

252

View full text Add to dashboard Cite

show abstract

“…According to the National Comprehensive Cancer Network guidelines, LIPs should attempt opioid dose reductions in patients with well controlled chronic pain followed by referral to a supportive care interdisciplinary team for a comprehensive pain‐management plan . In a 2018 study, the interdisciplinary team at The University of Texas MD Anderson Cancer Center decreased the median number of nonmedical opioid uses from 3 to 0.4 per month and decreased the morphine‐equivalent daily dose from 165 to 112 mg daily …”

Section: Pancreatic Cancer‐related Symptom Managementmentioning

confidence: 99%

“…66 In a 2018 study, the interdisciplinary team at The University of Texas MD Anderson Cancer Center decreased the median number of nonmedical opioid uses from 3 to 0.4 per month and decreased the morphine-equivalent daily dose from 165 to 112 mg daily. 67 For severe pain that is refractory to oral and parenteral opioids, interventional therapies are sometimes beneficial for localized PDAC. The most common method is a celiac plexus block, which involves a disruption of visceral pain innervation from the pancreas and surrounding structures through an injection of corticosteroids or long-acting anesthetic.…”

Section: Pancreatic Cancer-related Symptom Managementmentioning

confidence: 99%

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

Moffat

Epstein

O’Reilly

2019

Cancer

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Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5‐year relative survival rate compared with all other solid tumor malignancies and is expected to become the second‐leading cause of cancer‐related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient‐based advance care planning, and utilization of electronic patient‐reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease‐related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.

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“…[51][52][53] Universal screening for substance use disorder risk and more frequent follow-up and monitoring of patients at increased risk or with documented aberrant behaviors can be easily implemented in the clinical setting.…”

Section: The Role Of Physiciansmentioning

confidence: 99%

The opioid epidemic in the United States—Overview, origins, and potential solutions

Jones

Bruera

Abdi

et al. 2018

Cancer

Self Cite

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Outcomes of a Specialized Interdisciplinary Approach for Patients with Cancer with Aberrant Opioid-Related Behavior

Cited by 54 publications

References 49 publications

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

The opioid epidemic in the United States—Overview, origins, and potential solutions

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