Prescription Opioids Dispensed to Patients with Cancer with Bone Metastasis: 2011–2017

Zhang, Hao; Paice, Judith A.; Portenoy, Russell K.; Bruera, Éduardo; Reid, M. Carrington; Bao, Yuhua

doi:10.1002/onco.13898

Cited by 22 publications

(16 citation statements)

References 10 publications

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“…92 These regulations and other measures designed to mitigate the opioid misuse epidemic have been associated with decreased opioid prescribing in cancer and noncancer pain and have even been noted in those patients entering hospice. [93][94][95][96][97][98] One study observed a correlation between decreased opioid prescribing and an increase in cancer pain-related emergency department visits. 96 The most vulnerable patients remain the most affected, with reduced rates of opioid prescribing, along with lower doses, reported in people of color.…”

Section: Barriers To Opioid Accessmentioning

confidence: 99%

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Paice

Bohlke

Barton

et al. 2023

JCO

Self Cite

100

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PURPOSE To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time. RECOMMENDATIONS Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management. Additional information is available at www.asco.org/supportive-care-guidelines .

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Section: Barriers To Opioid Accessmentioning

confidence: 99%

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Paice

Bohlke

Barton

et al. 2023

JCO

Self Cite

100

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“…When patients are given a prescription, several studies report a reduction in the MME prescribed by oncologists. One study revealed a decrease in MME from 78 to 40 mg [ 20 ] and a decline in MME of 37% from 2011 to 2017 for people with cancer-related bone metastases [ 21 ▪ ]. Another large study of Medicare fee-for-service decedents with poor prognosis cancers found a drop in the MME from 85.6 mg to 64.6 mg and fewer individuals receiving a long acting opioid [ 22 ▪▪ ].…”

Section: Opioid Use: Benefits and Challengesmentioning

confidence: 99%

Cancer pain during an epidemic and a pandemic

Paice

2022

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review As our global population ages, cancer has become more prevalent. Thankfully, oncologic treatments are highly effective, leading to significantly improved rates of long-term survival. However, many of these therapies are associated with persistent pain syndromes. Clinicians caring for people with cancer must understand how the influence of the current epidemic of opioid misuse and the coronavirus disease 2019 (COVID-19) pandemic have complicated cancer pain management. Creative solutions can emerge from this knowledge. Recent findings Persistent pain due to cancer and its treatment can be managed through multimodal care, although efforts to mitigate the opioid misuse epidemic have created challenges in access to appropriate treatment. Isolation measures associated with the COVID-19 pandemic have limited access to nonpharmacologic therapies, such as physical therapy, and have exacerbated mental health disorders, including anxiety and depression. Summary Cancer pain treatment requires more nuanced assessment and treatment decisions as patients live longer. Societal factors multiply existing challenges to cancer pain relief. Research is needed to support safe and effective therapies.

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“…As the opioid overdose crisis has evolved, there has been a broad movement away from treatment of pain with opioids; 41,42 however, because opioids are the gold‐standard for treating cancer pain, undertreatment of pain has become a devastating issue for patients with cancer 43–45 . On the other hand, patients at risk of NMOU tend to escalate their opioid use at disproportionate levels, use higher opioid doses, 4 and require a relatively longer time to be weaned off opioids 46,47 .…”

Section: Discussionmentioning

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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Prescription Opioids Dispensed to Patients with Cancer with Bone Metastasis: 2011–2017

Cited by 22 publications

References 10 publications

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Cancer pain during an epidemic and a pandemic

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

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