Prospective Screening With the Validated Opioid Risk Tool Demonstrates Gynecologic Oncology Patients Are at Low Risk for Opioid Misuse

Garcia, Christine; Lefkowits, Carolyn; Pelkofski, E.; Blackhall, Leslie; Duska, Linda R.

doi:10.1097/ogx.0000000000000512

Cited by 5 publications

(26 citation statements)

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“…The grey literature search did not yield any results that met our study eligibility criteria. We contacted authors of 13 studies [53][54][55][56][57][58][59][68][69][70][71][72][73] and received responses from six authors, 54,55,[69][70][71][72] who provided additional data for four studies. 54,55,69,72 We identified two types of tools used to assess for problematic opioid use in palliative care: questionnaires (n = 32, 76%) [53][54][55]57,58,[61][62][63]65,66, and urine drug tests (n = 21, 50%), 17,53,55,56,57,59,60,63,64,67,68,70,71,81,82,85,…”

Section: Resultsmentioning

confidence: 99%

“…53,54,57,58,61,71,72,73,85 Previous attempts had been made to validate this tool as a measure of problematic opioid use in chronic non-cancer pain (Supplemental Appendix D). Our included studies reportedly used the ORT to assess for the following constructs in palliative care: opioid abuse, 54,58,61,73 dependence, 69 misuse, 53,54,57,58,72,73,85 diversion, 54 aberrant behaviors, [71][72][73] and safety. 53,57 Three studies used the ORT to measure general substance abuse 71 and misuse (Table 3).…”

Section: Cut Down Annoyed Guilty and Eye-opener (Cage)mentioning

confidence: 99%

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Assessment tools for problematic opioid use in palliative care: A scoping review

et al. 2021

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Background: Screening for problematic opioid use is increasingly recommended in patients receiving palliative care. Aim: To identify tools used to assess for the presence or risk of problematic opioid use in palliative care. Design: Scoping review. Data sources: Bibliographic databases (inception to January 31, 2020), reference lists, and grey literature were searched to find primary studies reporting on adults receiving palliative care and prescription opioids to manage symptoms from advanced cancer, neurodegenerative diseases, or end-stage organ diseases; and included tools to assess for problematic opioid use. There were no restrictions based on study design, location, or language. Results: We identified 42 observational studies (total 14,431 participants) published between 2009 and 2020 that used questionnaires ( n = 32) and urine drug tests ( n = 21) to assess for problematic opioid use in palliative care, primarily in US ( n = 38) and outpatient palliative care settings ( n = 36). The questionnaires were Cut down, Annoyed, Guilty, and Eye-opener (CAGE, n = 8), CAGE-Adapted to Include Drugs (CAGE-AID, n = 6), Opioid Risk Tool ( n = 9), Screener and Opioid Assessment for Patients with Pain (SOAPP; n = 3), SOAPP-Revised ( n = 2), and SOAPP-Short Form ( n = 5). Only two studies’ primary objectives were to evaluate a questionnaire’s psychometric properties in patients receiving palliative care. There was wide variation in how urine drug tests were incorporated into palliative care; frequency of abnormal urine drug test results ranged from 8.6% to 70%. Conclusion: Given the dearth of studies using tools developed or validated specifically for patients receiving palliative care, further research is needed to inform clinical practice and policy regarding problematic opioid use in palliative care.

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Section: Resultsmentioning

confidence: 99%

Section: Cut Down Annoyed Guilty and Eye-opener (Cage)mentioning

confidence: 99%

Assessment tools for problematic opioid use in palliative care: A scoping review

et al. 2021

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“…However, more recent studies have reported that the rate of opioid addiction or aberrant behavior is increasing in this patient population. The prevalence of OAB was reported as low as 7.7% and as high as 43% in these more recent studies [10][11][12][13][14]22]. Thus, it is likely that the overall prevalence of OAB in cancer patients is no longer low.…”

Section: Discussionmentioning

confidence: 99%

“…The original study presented no information about the primary diagnosis of the subjects. In cancer patients, the risk of OAB has been reported to vary considerably, from 10% to 40% [10][11][12][13][14]. In a study comparing ORT of cancer patients and heart failure patients, the proportion of moderate-to highrisk patients was higher in cancer patients (39% versus 23%), although the difference was not statistically signi cant [25].…”

Section: Discussionmentioning

confidence: 99%

“…With respect to cancer patients, the risk of OAB varies considerably according to cancer type and treatment situation. Moderate to high risk of OAB predicted by ORT has been reported in approximately 15-43% of cancer patients [10][11][12]. In a recent study using different screening tools, 10-39% of cancer patients receiving supportive care were noted to be at risk of OAB [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Risk of opioid-related aberrant behaviors predicted by Opioid Risk Tool among cancer patients receiving opioid analgesics

Park

et al. 2021

Preprint

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Purpose: The risk of opioid-related aberrant behavior (OAB) in Korean cancer patients has not been previously evaluated. The purpose of this study was to investigate the Opioid Risk Tool (ORT) in Korean cancer patients receiving opioid treatment.Methods: Data were obtained from a multicenter, cross-sectional, nationwide observational study regarding breakthrough cancer pain. The study was conducted in 33 South Korean institutions from March 2016 to December 2017. Patients were eligible if they had cancer-related pain within the past 7 days, which was treated with strong opioids in the previous 7 days.Results: We analyzed ORT results of 947 patients. Only one patient in each sex (0.2%) was classified as high risk for OAB. In patients with an ORT score of 1 or higher, the score primarily represented positive responses for personal history of depression, personal or family history of alcohol abuse, or 16–45 years age range. These patients had more severe average and worst pain scores and used rescue analgesics more frequently than patients with ORT scores of 0. The proportion of moderate- or high-risk patients according to ORT was lower in patients receiving low doses of long-acting opioids than in those receiving high doses (2.0% vs. 6.6%, p = 0.030). Moderate or high risk was more frequent when ORT was completed in an isolated room than in an open, busy place (2.7% vs. 0.6%, p = 0.091).Conclusion: The risk of OAB measured by ORT was very low in cancer patients receiving strong opioids for analgesia.

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A systematic review of assessment approaches to predict opioid misuse in people with cancer

Keall¹,

Keall

Kiani

et al. 2022

Support Care Cancer

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Context Cancer prevalence is increasing, with many patients requiring opioid analgesia. Clinicians need to ensure patients receive adequate pain relief. However, opioid misuse is widespread, and cancer patients are at risk. Objectives This study aims (1) to identify screening approaches that have been used to assess and monitor risk of opioid misuse in patients with cancer; (2) to compare the prevalence of risk estimated by each of these screening approaches; and (3) to compare risk factors among demographic and clinical variables associated with a positive screen on each of the approaches. Methods Medline, Cochrane Controlled Trial Register, PubMed, PsycINFO, and Embase databases were searched for articles reporting opioid misuse screening in cancer patients, along with handsearching the reference list of included articles. Bias was assessed using tools from the Joanna Briggs Suite. Results Eighteen studies met the eligibility criteria, evaluating seven approaches: Urine Drug Test (UDT) (n = 8); the Screener and Opioid Assessment for Patients with Pain (SOAPP) and two variants, Revised and Short Form (n = 6); the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) tool and one variant, Adapted to Include Drugs (n = 6); the Opioid Risk Tool (ORT) (n = 4); Prescription Monitoring Program (PMP) (n = 3); the Screen for Opioid-Associated Aberrant Behavior Risk (SOABR) (n = 1); and structured/specialist interviews (n = 1). Eight studies compared two or more approaches. The rates of risk of opioid misuse in the studied populations ranged from 6 to 65%, acknowledging that estimates are likely to have varied partly because of how specific to opioids the screening approaches were and whether a single or multi-step approach was used. UDT prompted by an intervention or observation of aberrant opioid behaviors (AOB) were conclusive of actual opioid misuse found to be 6.5–24%. Younger age, found in 8/10 studies; personal or family history of anxiety or other mental ill health, found in 6/8 studies; and history of illicit drug use, found in 4/6 studies, showed an increased risk of misuse. Conclusions Younger age, personal or familial mental health history, and history of illicit drug use consistently showed an increased risk of opioid misuse. Clinical suspicion of opioid misuse may be raised by data from PMP or any of the standardized list of AOBs. Clinicians may use SOAPP-R, CAGE-AID, or ORT to screen for increased risk and may use UDT to confirm suspicion of opioid misuse or monitor adherence. More research into this important area is required. Significance of results This systematic review summarized the literature on the use of opioid misuse risk approaches in people with cancer. The rates of reported risk range from 6 to 65%; however, true rate may be closer to 6.5–24%. Younger age, personal or familial mental health history, and history of illicit drug use consistently showed an increased risk of opioid misuse. Clinicians may choose from several approaches. Limited data are available on feasibility and patient experience. PROSPERO registration number. CRD42020163385.

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Prospective Screening With the Validated Opioid Risk Tool Demonstrates Gynecologic Oncology Patients Are at Low Risk for Opioid Misuse

Abstract: (Abstracted from Gynecol Oncol 2017;147:456–459) Mortality rates in the United States due to opioid misuse have risen in recent years and continue to rise. Many of these deaths were attributed to misuse of prescription drugs.

Cited by 5 publications

References 0 publications

Assessment tools for problematic opioid use in palliative care: A scoping review

Assessment tools for problematic opioid use in palliative care: A scoping review

Risk of opioid-related aberrant behaviors predicted by Opioid Risk Tool among cancer patients receiving opioid analgesics

A systematic review of assessment approaches to predict opioid misuse in people with cancer

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