Opioid Prescribing and Use Among Cancer Survivors: A Mapping Review of Observational and Intervention Studies

Check, Devon K.; Avecilla, Renee A V; Mills, Robert C.; Dinan, Michaela A.; Kamal, Arif H.; Murphy, Beverly; Rezk, Salma; Winn, Aaron N.; Oeffinger, Kevin C.

doi:10.1016/j.jpainsymman.2021.10.015

Cited by 7 publications

(9 citation statements)

References 138 publications

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“…Nevertheless, male patients seem to be at higher risk and opioids overdoses are more frequent in patients treated for head and neck cancers and myeloma. Opioid prescribing and use among cancer survivors is currently under consideration as it is in non-cancer chronic pain patients [11]. Besides the effects of chronic opioid intake on the immune system functioning, longterm opioid therapy may induce a state called "hyperkatifeia" i.e.…”

Section: Adverse Effects and Harms Related To Long-term Opioids Intakementioning

confidence: 99%

“…The opioids crisis which has highlighted the life threatening side effects of opioids has prompted the reassessment of opioids use to treat pain (acute pain, chronic non-cancer and cancer pain). Opioids dependence, abuse and misuse, problems most feared in chronic non-cancer pain patients, are now scrutinized in cancer patients and cancer survivors [10,11]. More, the interest for non-pharmacologic treatments in pain management is increasing.…”

Section: Introductionmentioning

confidence: 99%

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Cancer Pain Management - Current Concepts, Strategies and Management Techniques

Mestdagh¹,

Steyaert²,

Lavand’homme³

2023

Preprint

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Pain is frequently reported during cancer disease, and still remains poorly controlled in 40% of patients. Recent developments in oncology have helped to better control pain. Targeted treatments may cure cancer disease and significantly increase survival. Thereby, a novel population of patients (cancer survivors) has emerged, also enduring chronic pain (27.6% moderate to severe pain). The present review discuss the different options currently available to manage pain in (former) cancer patients in the light of progress made in the last decade. Major progress in the field are recent development of a chronic cancer pain taxonomy now included in International Classification of Diseases (ICD-11) and update of WHO analgesic ladder. Until recently, cancer pain management has mostly relied on pharmacotherapy, opioids being considered as mainstay. The opioids crisis has prompted the reassessment of opioids use, both in cancer patients and cancer survivors. The review focuses on the current utilization of opioids, on the neuropathic pain component often neglected and on techniques and non-pharmacological strategies available which help to personalize patient’s treatment. Cancer pain management is now closer to the management of chronic non-cancer pain i.e. “an integrative pain care” aiming to improve patient’s quality of life.

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Section: Adverse Effects and Harms Related To Long-term Opioids Intakementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cancer Pain Management - Current Concepts, Strategies and Management Techniques

Mestdagh¹,

Steyaert²,

Lavand’homme³

2023

Preprint

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“…Prescription opioids are commonly used for treating cancer-related pain [7][8][9]; however, there are emerging safety concerns (e.g., OUD and OD) for use of chronic opioid therapy among long-term cancer survivors, such as breast cancer (BC) [10][11][12]. Given the limited evidence on the effectiveness of opioids and potential risks (e.g., OD), the National Comprehensive Cancer Network guidelines recommend using the lowest opioid dose and minimum duration with regular risk-bene t assessments for long-term cancer survivors [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Association Between Trajectories of Prescription Opioid Use and Risk of Opioid Use Disorder and Overdose Among US Nonmetastatic Breast Cancer Survivors

Chang

Jones

Hincapie-Castillo³

et al. 2023

Preprint

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Purpose To examine the association between prescription opioid use trajectories and risk of opioid use disorder (OUD) or overdose among nonmetastatic breast cancer survivors by treatment type. Methods This retrospective cohort study included female nonmetastatic breast cancer survivors with at least 1 opioid prescription fill in 2010–2019 Surveillance, Epidemiology and End Results linked Medicare data. Opioid mean daily morphine milligram equivalents (MME) calculated within 1.5 years after initiating active breast cancer therapy. Group-based trajectory models identified distinct opioid use trajectory patterns. Risk of time to first OUD/overdose event within 2.5 years after breast cancer therapy initiation was calculated for distinct trajectory groups using Cox proportional hazards models. Analyses were stratified by treatment type. Results Four opioid use trajectories were identified for each treatment group. For 38,265 survivors with systemic endocrine therapy, 3 trajectories were associated with increased OUD/overdose risk compared with early discontinuation: minimal dose (< 5 MME; adjusted hazard ratio [aHR] = 4.46 [95% CI = 3.09–6.43]), very low dose (5–25 MME; 15.60 [10.74–22.67]), and moderate dose (51–90 MME; 58.55 [39.92–85.86]). For 9,558 survivors with adjuvant chemotherapy, 3 trajectories were associated with higher OUD/overdose risks compared with early discontinuation: minimal dose (aHR = 3.80 [95% CI = 1.98–7.32]), low dose (26–50 MME; 11.66 [6.01–22.61]), and high dose (91–150 MME; 16.49 [5.90-46.09]). For 3,550 survivors with neoadjuvant chemotherapy, low-dose opioid use was associated with higher OUD/overdose risk (aHR = 5.60 [95% CI = 1.91–16.45]) compared with minimal-dose use. Conclusions Among Medicare nonmetastatic breast cancer survivors receiving systemic endocrine therapy or adjuvant chemotherapy, compared with early discontinuation, moderate-dose and high-dose opioid use were associated with 17- to 59-fold higher OUD/overdose risk. For females receiving neoadjuvant chemotherapy, low-dose opioid use was associated with 6-fold higher OUD/overdose risk compared with minimal-dose use. Breast cancer survivors at high-risk of OUD/overdose may benefit from targeted interventions (e.g., pain clinic referral).

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“…Unfortunately, strategies for addressing NMOU are limited by a lack of validated methods and the inherent logistical challenges associated with the conflicting goals of managing pain while limiting opioids. There is a paucity of high‐quality data in the literature pertaining to substance abuse, misuse, and diversion in the oncology setting 5,6 . Clinical interventions for these extremely complex and rapidly growing population do not exist.…”

Section: Introductionmentioning

confidence: 99%

“…There is a paucity of high-quality data in the literature pertaining to substance abuse, misuse, and diversion in the oncology setting. 5,6 Clinical interventions for these extremely complex and rapidly growing population do not exist.…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain

Arthur

Edwards

et al. 2022

Cancer

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BACKGROUND: Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention. METHODS: A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained. RESULTS: NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13). CONCLUSIONS: Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior.

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Opioid Prescribing and Use Among Cancer Survivors: A Mapping Review of Observational and Intervention Studies

Cited by 7 publications

References 138 publications

Cancer Pain Management - Current Concepts, Strategies and Management Techniques

Cancer Pain Management - Current Concepts, Strategies and Management Techniques

Association Between Trajectories of Prescription Opioid Use and Risk of Opioid Use Disorder and Overdose Among US Nonmetastatic Breast Cancer Survivors

Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain

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