Persistent pain in cancer survivors

Boland, Elaine; Ahmedzai, Sam H

doi:10.1097/spc.0000000000000292

Cited by 29 publications

(31 citation statements)

References 84 publications

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“…While nonopioid measures alone can often treat mild cancer‐related pain, opioids may be needed for treating more severe pain . However, there have been growing concerns regarding long‐term opioid therapy in older cancer survivors, in part due to the worsening epidemic of opioid toxicity in the United States …”

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confidence: 99%

Long‐Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Shah

Chou

Kuo

et al. 2019

J American Geriatrics Society

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OBJECTIVES To examine the rates and predictors of long‐term opioid therapy in older cancer survivors. DESIGN Retrospective cohort study. SETTING Texas, United States. PARTICIPANTS Cancer survivors (5 years or more postcancer diagnosis) diagnosed from 1995 to 2008 and who were also Medicare Parts A, B, and D beneficiaries. MEASUREMENTS We used Medicare Part D event data to calculate the proportion of cancer survivors with a prolonged opioid prescription (90‐day or more supply of opioids/year). Adjusted odds ratios were calculated to identify predictors of prolonged opioid prescribing. All analyses were repeated with a subcohort of opioid‐naïve cancer survivors. RESULTS The rate of prolonged opioid therapy for cancer patients diagnosed in 2008 was 7.1% prior to cancer diagnosis; it rose to 9.8% within a year of cancer treatments, and to 13.3% at 5 years postdiagnosis. The rate at the sixth year varied by cancer sites: 19.4% in lung cancer and 9.6% in prostate cancer. Among opioid‐naïve survivors, the rate increased from 1.4% to 7.1%, from 5 to 18 years postcancer diagnosis. Cancer survivors diagnosed in 2004 to 2008 had higher rates of opioid prescribing compared to those diagnosed in 1995 to 1998 and 1999 to 2003. Years since diagnosis, a later year of diagnosis, female sex, urban location, lung cancer diagnosis, disability as reason for Medicare entitlement, Medicaid eligibility, one or more comorbidity, and history of depression or drug abuse were predictors of prolonged opioid therapy. Among opioid‐naïve cancer survivors, diagnosis in 2004 to 2008 was the strongest predictor, while a history of drug abuse was the strongest predictor for all the survivors. CONCLUSION The rates of prolonged opioid prescribing for older cancer survivors remained high at 5 or more years after cancer diagnosis. Our findings have potential to inform the development of clinical guidelines and public policy to ensure safer and more effective pain treatment in older cancer survivors. J Am Geriatr Soc 67:945–952, 2019.

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confidence: 99%

Long‐Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Shah

Chou

Kuo

et al. 2019

J American Geriatrics Society

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“…Pain is the commonest symptom of cancer at diagnosis (Breivik et al, ) and rises in prevalence throughout and beyond cancer treatment (van den Beuken‐van Everdingen et al, ). Between 33% and 40% of cancer survivors (persons with cancer whose curative treatment was completed) suffer from chronic pain (Boland and Ahmedzai, ; Paice, ; Seretny et al, ). In contrast, 1.7 million European cancer patients die from their disease each year of whom at least 66% will experience pain before death and 55% will experience moderate‐to‐severe intensity pain (Ferlay et al, ; van den Beuken‐van Everdingen et al, ).…”

Section: Introductionmentioning

confidence: 99%

Standards for the management of cancer‐related pain across Europe—A position paper from the EFIC Task Force on Cancer Pain

Bennett

Eisenberg

Ahmedzai

et al. 2019

European Journal of Pain

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Background and objective Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Evidence from meta‐analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self‐management and late or inadequate access to strong opioid analgesia in those with advanced disease. Methods The European Pain Federation (EFIC) established a Task Force in 2017 which convened a European group of experts, drawn from a diverse range of relevant clinical disciplines, to prepare a position paper on appropriate standards for the management of cancer‐related pain. The expert panel reviewed the available literature and made recommendations using the GRADE system to combine quality of evidence with strength of recommendation. The panel took into account the desirable and undesirable effects of the management recommendation, including the cost and inconvenience of each when deciding the recommendation. Results and conclusions The 10 standards presented are aimed to improve cancer pain management and reduce variation in practice across Europe. The Task Force believes that adoption of these standards by all 37 countries will promote the quality of care of patients with cancer‐related pain and reduce unnecessary suffering. Significance Pain affects up to 40% of cancer survivors and affects at least 66% of patients with advanced progressive disease, many of whom experience poor pain control. These 10 standards are aimed to improve cancer pain management, promote the quality of care of patients and reduce variation across Europe.

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“…Significant progress has recently been made in its treatment, which led to a longer survival, but also to an increasing number of patients living with either stable disease or advancing cancer (Greer, Jackson, Meier, & Temel, 2013) and the symptoms thereof. The latter include pain arising from the primary cancer and from the consequences of cancer treatments (Boland & Ahmedzai, 2017).…”

Section: Introductionmentioning

confidence: 99%

Cancer‐related chronic pain: Investigation of the novel analgesic drug candidate cebranopadol in a randomized, double‐blind, noninferiority trial

Eerdekens

Kapanadze

Koch

et al. 2019

European Journal of Pain

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Background Cancer‐related pain is a growing health problem given the increasing life expectancy of cancer patients. Opioids are commonly used to treat cancer‐related pain, but carry the risk of severe side effects, limiting their use. Cebranopadol is a first‐in‐class drug candidate, combining nociceptin/orphanin FQ peptide and opioid peptide receptor agonism. This trial examined the analgesic efficacy of cebranopadol compared with morphine prolonged release (PR) in patients with moderate‐to‐severe cancer‐related pain. Methods This double‐blind, parallel‐group, multiple‐dose trial was designed as noninferiority trial for efficacy of cebranopadol versus morphine PR. Planned with 524 patients, finally 126 patients were treated for up to 7 weeks (low accrual). The primary efficacy endpoint was the average amount of daily rescue medication intake (morphine immediate release) over the last 2 weeks of treatment. Results For the primary endpoint, noninferiority of cebranopadol with and superiority over morphine PR were demonstrated (Full Analysis Set: ∆[95%CI] = −7.48 mg [−12.05, −2.92]; Per Protocol Set: ∆[95%CI] = −4.67 mg [−9.25, −0.10]). The vast majority of patients (≥75%, either treatment) had clinically relevant pain reduction, and noninferiority on this secondary endpoint was not shown. Mostly used doses were ≤800 μg cebranopadol or ≤120 mg morphine PR daily. A total of 83.1% of patients on cebranopadol and 82.0% on morphine PR experienced treatment‐emergent adverse events. Conclusions Cebranopadol was effective, safe and well tolerated in the dose range tested (200–1,000 μg) in patients suffering from chronic moderate‐to‐severe cancer‐related pain and was superior to morphine PR on the primary endpoint. Significance Cebranopadol presents a new approach to treat cancer pain. The drug candidate was easy to titrate, safe and well tolerated, and as effective as morphine PR in patients suffering from chronic moderate‐to‐severe cancer‐related pain

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Persistent pain in cancer survivors

Cited by 29 publications

References 84 publications

Long‐Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Long‐Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

Standards for the management of cancer‐related pain across Europe—A position paper from the EFIC Task Force on Cancer Pain

Cancer‐related chronic pain: Investigation of the novel analgesic drug candidate cebranopadol in a randomized, double‐blind, noninferiority trial

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