The development of a nomogram to determine the risk for inappropriate opioid use in cancer patients.

Abstract

11602 Background: Non-Medical opioid use is a growing crisis. Cancer patients at risk of harmful use of prescribed opioids are frequently underdiagnosed. The aim was to develop a nomogram to predict the probability of occurrence of Inappropriate opioid use that is, presence of SOAPP ≥ 7) among patients receiving outpatient supportive care consultation at a comprehensive cancer center. Methods: 3588 consecutive cancer patients referred to a supportive care clinic from March 1, 2016 to July 15, 2018 were reviewed. Patients were eligible if they had diagnosis of cancer, and were on opioids for pain for at least a week. All patients were assessed using Edmonton Symptom Assessment Scale with spiritual pain and financial distress (ESAS-FS), MEDD (morphine equivalent daily dose), SOAPP-14 (validated questionnaire for assessment of risk of inappropriate opioid use, and CAGE-AID (screening questionnaire for alcoholism/substance use disorder). Patients at with SOAPP+ were defined by SOAPP score ≥7. A nomogram was devised based on the risk factors determined in the multivariate logistic regression model and it can be used to estimate the probability of inappropriate opioid use. Results: Median age was 62yrs. Median ESAS pain item score on consultation was 5, Median ECOG was 2.20.4% were SOAPP+ and 10.1% were CAGE-AID+. SOAPP+ was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD and CAGE score. The C-index is 0.8(CI 0.78, 0.82). A nomogram was developed. For example, for a male Hispanic patient, who is married, never smoked, with the following ESAS scores: (depression = 3, anxiety = 3, financial distress = 8), CAGE score of 0, and MEDD of 20, the total score is 9+9+0+0+6+10+26+0+1 = 61. In the nomogram a score of 58 indicates the probability of inappropriate opioid use being 0.1 and a score of 88 indicates the probability of 0.2. Based on the patient’s total score of 61, the probability of his aberrant behavior is between 10% to 20% (close to 10%). Conclusions: A nomogram can predict the risk of inappropriate opioid use in cancer patients.

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

“…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,[89]…”

“…We identified two types of tools used to assess for problematic opioid use in palliative care: questionnaires ( n = 32, 76%) 53–55,57,58,61–63,65,66,68–89 and urine drug tests ( n = 21, 50%), 17,53,55,56,57,59,60,63,64,67,68,70,71,81,82,85,89–93 with an overlap of both types in 11 studies (26%). 53,55,57,63,68,70,71,81,82,85,89 Two studies did not specify which questionnaire they used.…”

“…Most studies ( n = 30, 94%) were conducted in outpatient clinics 53–55,57,58,61–63,65,66,68–79,81–83,85–89 and in the US ( n = 28, 88%), 53–55,57,58,61,62,63,65,66,69–79,81–83,85–87,89 and published between 2009 and 2020. The same tertiary cancer center conducted many of the studies ( n = 16, 50%): CAGE ( n = 7, 44%), 74–80 CAGE-AID ( n = 6, 37.5%), 62,81…”

“…68 , 88 The primary study objective of 22 studies (52%) was to evaluate the use of one or more assessment tools in palliative care. 53 – 63 , 66 , 68 – 73 , 82 , 85 , 91 , 93 In the remaining studies, the primary objectives were to describe patients with problematic opioid use who were receiving palliative care ( n = 17, 40%); 60 , 64 , 67 , 74 – 81 , 84 , 86 – 88 , 90 , 92 and to evaluate the impact of interventions related to problematic opioid use in palliative care ( n = 3, 7%) 17 , 83 , 89 ( Table 2 ). Though evaluation of the tools was not the primary objective in these studies, they reported on use of these tools to assess for problematic opioid use.…”

“…The following questionnaires were used in the studies included in our review: Cut down, Annoyed, Guilty, and Eye-opener (CAGE, n = 8, 25%), 70 , 74 – 80 CAGE-Adapted to Include Drugs (CAGE-AID; n = 6, 28%), 62 , 69 , 81 – 83 , 89 Opioid Risk Tool (ORT) ( n = 9, 28%), 53 , 54 , 57 , 58 , 61 , 71 – 73 , 85 Screener and Opioid Assessment for Patients with Pain (SOAPP) ( n = 3, 9%), 65 , 66 , 69 SOAPP-Revised (SOAPP-R; n = 2, 6%), 55 , 87 and SOAPP-Short Form (SOAPP-SF; n = 5, 16%) 54 , 63 , 70 , 75 , 86 Four studies (13%) used two different questionnaires; 54 , 69 , 70 , 75 one study (3%) used a self-designed opioid dependence assessment; 88 one study (3%) used a 5-point Likert scale to measure opioid craving; 84 and one study (3%) did not specify the questionnaire that they used. 68 Supplemental Appendix D 3 provides information about the development and validation studies for CAGE, CAGE-AID, ORT, SOAPP, SOAPP-SF, and SOAPP-R questionnaires.…”