The development of a nomogram to determine the frequency of elevated risk for non-medical opioid use in cancer patients

Abstract

Objective Non-medical opioid use (NMOU) is a growing crisis. Cancer patients at elevated risk of NMOU (+risk) are frequently underdiagnosed. The aim of this paper was to develop a nomogram to predict the probability of +risk among cancer patients receiving outpatient supportive care consultation at a comprehensive cancer center. Method 3,588 consecutive patients referred to a supportive care clinic were reviewed. All patients had a diagnosis of cancer and were on opioids for pain. All patients were assessed using the Edmonton Symptom Assessment Scale (ESAS), Screener and Opioid Assessment for Patients with Pain (SOAPP-14), and CAGE-AID (Cut Down-Annoyed-Guilty-Eye Opener) questionnaires. “+risk” was defined as an SOAPP-14 score of ≥7. A nomogram was devised based on the risk factors determined by the multivariate logistic regression model to estimate the probability of +risk. Results 731/3,588 consults were +risk. +risk was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD (morphine equivalent daily dose), and CAGE-AID score. The C-index was 0.8. A nomogram was developed and can be accessed at https://is.gd/soappnomogram. For example, for a male Hispanic patient, married, never smoked, with ESAS scores for depression = 3, anxiety = 3, financial distress = 7, a CAGE score of 0, and an MEDD score of 20, the total score is 9 + 9+0 + 0+6 + 10 + 23 + 0+1 = 58. A nomogram score of 58 indicates the probability of +risk of 0.1. Significance of results We established a practical nomogram to assess the +risk. The application of a nomogram based on routinely collected clinical data can help clinicians establish patients with +risk and positively impact care planning.

When treatment algorithms fail: A response to the development of a nomogram to determine the frequency of elevated risk for non-medical opioid use in cancer patients

“…Recent publications caution against the use of race in such algorithms (Vyas et al, 2020). The nomogram in this article finds that a Black patient matched with a White patient for all other categories would be at elevated risk for NMOU (Yennurajalingam et al, 2021). Disappointingly, the authors neither reflect on why this may be true in their clinic setting nor mention structural or other forms of racism.…”

“…We read the February 2021 article by Yennurajalingam et al (2021) with great interest given the growing recognition that individuals with cancer remain at risk for opioid misuse and overdose (Tan et al, 2015). Caring for this patient population requires carefully balancing risks to manage cancer-related pain while keeping patients safe from the risk of potential overdose (Alyssa et al, 2020).…”

“…Caring for this patient population requires carefully balancing risks to manage cancer-related pain while keeping patients safe from the risk of potential overdose (Alyssa et al, 2020). The authors developed a nomogram to help identify patients at-risk for non-medical opioid use (NMOU) and include a patient's race as a risk factor (Yennurajalingam et al, 2021).…”

Risk estimation for non-medical opioid use in cancer patients

“…Dear Editor: I read the article by Yennurajalingam et al (2021a) with interest. The authors developed a nomogram to predict the risk of non-medical opioid use (NMOU) among cancer patients receiving outpatient supportive care.…”

Impact of “race” as a social variable for screening for the risk of non-medical opioid use using nomogram

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We thank Jones et al for their review and comments in response to our article, "The development of a nomogram to determine the frequency of elevated risk for non-medical opioid use [NMOU] in cancer patients" (Yennurajalingam et al, 2021a). In this study, we proposed a practical nomogram to assess the risk of NMOU.

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