Predictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

Check, Devon K.; Baggett, Christopher D.; Kim, KyungSu; Roberts, Andrew W.; Roberts, Megan C.; Robinson, Timothy J.; Oeffinger, Kevin C.; Dinan, Michaela A.

doi:10.1093/jnci/djab082

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…We also asked clinicians to reflect on a key finding from the quantitative phase of our research study: patients who use opioids chronically (ie, continuously for 3 months or longer) during active cancer treatment are likely to continue using opioids in the years following treatment completion. 16 Under the supervision of a qualitative methodology expert (L.J.F. ), four trained interviewers (L.J.F., and T.K.D.)…”

Section: Methodsmentioning

confidence: 99%

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

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Jones

Fish

et al. 2023

JCO Oncology Practice

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PURPOSE: Among cancer survivors who have completed curative-intent treatment, the high prevalence and adverse consequences of chronic pain are well documented. Yet, research on clinicians' experiences with and perspectives on managing chronic pain among cancer survivors is critically lacking. METHODS: We conducted semistructured interviews with 17 clinicians (six oncology, three palliative care, and eight primary care) affiliated with an academic medical center. Interview questions addressed clinicians' experiences with and perspectives on managing chronic pain (with or without opioid therapy) during the transition from active treatment to survivorship. A multidisciplinary team conducted content analysis of interview transcripts to identify and refine themes related to current practices and challenges in managing chronic pain in this context. RESULTS: Overall, clinicians perceived chronic pain to be relatively uncommon among cancer survivors. Identified challenges included a lack of clarity about which clinician (or clinicians) are best positioned to manage chronic pain among cancer survivors, and (relatedly) complexities introduced by long-term opioid management, with many clinicians describing this practice as outside their skill set. Additionally, although most clinicians recognized chronic pain as a biopsychosocial phenomenon, they described challenges with effectively managing psychosocial stressors, including difficulty accessing mental or behavioral health services for cancer survivors. CONCLUSION: Discovered challenges highlight unmet needs related to cancer survivor-clinician communication about chronic pain and the absence of a chronic pain management home for cancer survivors, including those requiring long-term opioid therapy. Research evaluating routine pain monitoring and accessible, tailored models of multimodal pain care in survivorship may help to address these challenges.

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Section: Methodsmentioning

confidence: 99%

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

Check

Jones

Fish

et al. 2023

JCO Oncology Practice

Self Cite

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“…The prevalence rate of pain related to cancer has been reported ranging from 50% to 75% in recent years, and one of the most common and suffering symptoms is pain from the bone metastasis. 1 The survival time of patients diagnosed with malignant diseases improved by progressive diagnostic and therapeutic strategies, which increased the prevalence rates of both bone metastasis and the accompanying bone cancer pain (BCP). 2 BCP usually happened to patients diagnosed with primary bone tumors or secondary metastatic bone tumors from breast, prostate, and lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Co-Administration of nalbuphine to improve morphine tolerance in mice with bone cancer pain

et al. 2023

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Background Kappa-opioid receptor (KOR) agonists are known for having opposite and/or different effects compared with Mu-opioid receptor (MOR) agonists. This study is aimed at clarifying the analgesic effect and tolerance of nalbuphine combined with morphine, and quantifying the mRNA and protein expression of spinal MOR and KOR in a mouse bone cancer pain (BCP) model treated with nalbuphine and morphine. Method BCP model was prepared in C3H/HeNCrlVr Mice by implanting the sarcoma cells into the intramedullary space of the femur. The paw withdrawal thermal latency (PWL) measured by thermal radiometer was used to assess thermal hyperalgesia. PWL testing was performed after implantation and drug administration according to the protocol. Hematoxylin-eosin staining in the spinal cord and x-ray in the femoral intramedullary canal was detected. Real-time PCR and western blot analysis played a role in detecting spinal MOR and KOR expression changes. Results In tumor-implanted mice, the spinal MOR and KOR protein and mRNA expression was down-regulated when compared to that in sham-implanted mice ( p < 0.05). Morphine therapy can lead to a decrease in spinal μ receptor expression. Similarly, the nalbuphine therapy can lead to a decrease in the expression of κ receptor protein and mRNA at the spinal cord level ( p < 0.05). Morphine, nalbuphine, or nalbuphine co-administration with morphine all can extend the paw withdrawal thermal latency (PWL) to radiant thermal stimulation in tumor-implanted mice ( p < 0.05). Compared with the morphine treatment group, nalbuphine co-administration with morphine delayed the reduction of PWL value again ( p < 0.05). Discussion BCP itself may induce down-regulation of the spinal MOR and KOR expression. A low dose of nalbuphine co-administration with morphine led to the delayed emergence of morphine tolerance. The part of the mechanism may be due to the regulation of spinal opioid receptors expression.

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Catchment area and cancer population health research through a novel population-based statewide database: a scoping review

Spees,

Albaneze,

Baggett

et al. 2024

JNCI Cancer Spectrum

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Background Population-based linked datasets are vital to generate catchment area and population health research. The novel Cancer Information & Population Health Resource (CIPHR) links statewide cancer registry data, public and private insurance claims, and provider- and area-level data, representing more than 80% of North Carolina’s large, diverse population of individuals diagnosed with cancer. This scoping review of articles that used CIPHR data characterizes the breadth of research generated and identifies further opportunities for population-based health research. Methods Articles published January 2012 - August 2023 were categorized by cancer site and outcomes examined across the care continuum. Statistically significant associations between patient-, provider-, and system/policy-level factors and outcomes were summarized. Results Among 51 articles, 42 reported results across 23 unique cancer sites and 13 aggregated across multiple sites. The most common outcomes examined were treatment initiation and/or adherence (n = 14), mortality/survival (n = 9), and health care resource utilization (n = 9). Few articles focused on cancer recurrence (n = 1) or distance to care (n = 1) as outcomes. Many articles discussed racial, ethnic, geographic, and socioeconomic inequities in care. Conclusions These findings demonstrate the value of robust, longitudinal, linked, population-based databases to facilitate catchment area and population health research aimed at elucidating cancer risk factors, outcomes, care delivery trends, and inequities that warrant intervention and policy attention. Lessons learned from years of analytics using CIPHR highlight opportunities to explore less-frequently studied cancers and outcomes, motivate equity-focused interventions, and inform development of similar resources.

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Predictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

Cited by 3 publications

References 33 publications

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment

Co-Administration of nalbuphine to improve morphine tolerance in mice with bone cancer pain

Catchment area and cancer population health research through a novel population-based statewide database: a scoping review

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