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

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Tonya Edwards ◽  
Joseph Arthur ◽  
Zhanni Lu ◽  
Elif Erdogan ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Elevated Risk ◽  
Comprehensive Cancer Center ◽  
Multivariate Logistic Regression Model ◽  
Cancer Center ◽  
Opioid Use ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale

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.

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

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11602-11602
Author(s):  
Sriram J. Yennu ◽  
Rony Dev ◽  
Tonya Edwards ◽  
Joseph Anthony Arthur ◽  
Zhanni Lu ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Comprehensive Cancer Center ◽  
Multivariate Logistic Regression Model ◽  
Cancer Center ◽  
Opioid Use ◽  
Care Clinic ◽  
Validated Questionnaire ◽  
Edmonton Symptom Assessment Scale

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.

Frequency and factors predicting the risk for aberrant opioid use in patients receiving outpatient palliative care at a comprehensive cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 228-228
Author(s):  
Sriram Yennu ◽  
Tonya Edwards ◽  
Joseph Anthony Arthur ◽  
Zhanni Lu ◽  
John M Najera ◽  
...  
Keyword(s):  
At Risk ◽  
Multivariate Analysis ◽  
Drug Use ◽  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Male Gender ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale

228 Background: Opioid misuse is a growing crisis among patients with chronic pain. Cancer patients at risk of aberrant drug behaviors (ADB) are frequently underdiagnosed in routine cancer care. The aim of this study was to determine the frequency and factors predicting risk for Aberrant Opioid and Drug use among Patients receiving Outpatient Supportive Care Consultation at a Comprehensive Cancer Center Methods: In this retrospective study, 690 consecutive patients referred to a supportive care clinic were reviewed. Patients were eligible if they were ≥18 years, had a diagnosis of cancer, and were on opioids for pain for atleast a week. All patients were assessed with the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID. At risk patients with aberrant opioid behavior (+Risk) was defined as SOAPP-14 score ≥7. Descriptive statistics, spearman correlation coefficient, multivariate analysis were performed. Results: 690/752 consults were eligible. A total of 135(20%)were +risk. 69(11%) were CAGE-AID +.SOAPP-14 scores were positively associated with CAGE-AID p < 0.001; male gender p = 0.007; ESAS pain p = < 0.006; ESAS depression p < 0.001; ESAS anxiety, p < 0.001, and ESAS financial distress p = < 0.001. Multivariate analysis indicated that the odds ratio for +Risk was 2.47 in patients with CAGE-AID+ (p < 0.001), 1.95 for male gender (p = 0.005), 1.11 per point for ESAS anxiety (p = 0.019), and 1.1 per point. for ESAS financial distress (p = 0.02). Conclusions: 20% of cancer patients on opioids presenting to supportive care center are at risk of aberrant drug behavior. Male patients with anxiety, financial distress, and prior alcoholism/illicit drug use are significant predictors of +Risk. Further research to effectively manage these patients is needed.

Frequency and prediction of non-medical opioid use behaviors (NMOU) among advanced cancer patients referred to a supportive care center (SCC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12086-12086
Author(s):  
Sriram Yennu ◽  
Joseph Anthony Arthur ◽  
Suresh Reddy ◽  
Tonya Edwards ◽  
Zhanni Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Supportive Care ◽  
Cancer Patients ◽  
Care Center ◽  
Multivariate Logistic Regression Model ◽  
Opioid Use ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale

12086 Background: One of the methodological barriers to conducting research on interventions for NOMU (Aberrant Opioid Use Behaviors) among cancer patients is the lack of data on the frequency of this problem. Although the frequency of risk factors has been established by our group and others, not all the patients with risk factors will be diagnosed with having NMOU behaviors, and some patients with no previous risk factors will engage in NMOU. AIM: To characterize the overall frequency of NMOU for a duration of 3 months, as well independent predictors for NMOU. Methods: In this retrospective study, 1558 consecutive patients referred to supportive care clinic (SCC) from 3/18/2016 to 6/6/2018 were reviewed for development of NMOU using established diagnostic criteria. Patients were eligible if they were ≥18 years, had a diagnosis of cancer, and were on opioids for pain for at least a week. All patients were assessed with the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID. Descriptive statistics, spearman correlation coefficient, multivariate analysis were performed. Results: 299 patients (19%) had ≥1 NMOU behavior. The median (IQR) NMOU behavior was 1 (1-2); range 1-10. Most NMOU occurred at 1st and 2nd follow up visits. The most frequent NMOU behavior was unscheduled clinic visit for inappropriate refills. 29/299 (10%) NMOU patients received specialized care for high-risk for aberrant opioid misuse by interdisciplinary team. Results of multivariate logistic regression model showed Marital status (Divorced vs. Married, OR=1.47, 95% CI: 0.98, 2.22, p=0.654 (marginally significant); Single vs. Married, OR=1.68, 95% CI: 1.15, 2.46, p=0.0079), SOAPP (Positive vs. Negative, OR=1.42, 95% CI: 1.05, 1.93, p=0.0238), morphine equivalent daily dose (MEDD) (OR=1.004, 95% CI: (1.003, 1.006), p<0.0001) and ESAS pain (OR=1.11, 95% CI: 1.06, 1.17, p<0.0001) were independently associated with the presence of NMOU during follow-up visits. Conclusions: 19% cancer patients followed at SCC had detectable NMOU behaviors. Being single, SOAPP+, pain severity and high MEDD were independent predictors for NMOU. This information will assist clinicians and investigators designing clinical and research programs in this important field.

Frequency and factors predictive of aberrant drug behavior in patients presenting to outpatient supportive care center at a comprehensive cancer center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10118-10118
Author(s):  
Sriram Yennu ◽  
Tonya Edwards ◽  
Joseph Anthony Arthur ◽  
Janet L. Williams ◽  
Zhanni Lu ◽  
...  
Keyword(s):  
At Risk ◽  
Supportive Care ◽  
Cancer Patients ◽  
Predictive Value ◽  
Financial Distress ◽  
Care Center ◽  
Male Gender ◽  
Comprehensive Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Outpatient Supportive Care

10118 Background: Opioid misuse is a growing crisis in cancer patients. Cancer patients at risk of aberrant drug behaviors (ADB) are frequently underdiagnosed in routine cancer care. The aim of this study was to determine the frequency and factors associated with ADB using the “Screener and Opioid Assessment for Patients tool” (SOAPP-14) in cancer patients seen at the outpatient supportive care center. We also examined the screening performance of Cut Down, Annoyed, Guilty, and Eye Opener (CAGE-AID) as compared to The SOAPP-14 as a gold standard. Methods: In this retrospective study, 1108 consecutive patients referred to supportive care clinic were reviewed. Patients were eligible if they were ≥18 yrs, have a diagnosis of cancer, and were on opioids for pain for atleast a week. Patients’ demographics, the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID scores were analyzed. ADB+ was defined as SOAPP-14 score ≥7. Descriptive statistics, spearman correlation coefficient, multivariate, and ROC analysis were performed. Results: 703/1108 consults were eligible. A total of 153/703 (22%) were ADB +ve. SOAPP-14 scores were positively correlated with CAGE-AID r = .38, p < 0.001; male gender r = 0.11, p = 0.003; ESAS pain r = 0.11, p = 0.005; ESAS depression r = 0.22, p < 0.001; ESAS anxiety r = 0.22, p < 0.001, and ESAS financial distress r = 0.23, p < 0.001. Multivariate analysis indicated that the odds ratio for ADB +ve was 6.18 in patients with CAGE-AID+ (p < 0.001), 1.8 for male gender (p = 0.007), 1.1/pt. for ESAS anxiety (p = 0.044), and 1.1/pt. for ESAS financial distress (p = 0.007). A CAGE-AID score of 1/4 has a sensitivity of 47%, specificity of 89% positive predictive value 63.6% and negative predictive value 69.2%. Conclusions: Our study suggests that 22% of cancer patients on opioids presenting to supportive care center are at risk of aberrant drug behavior (ADB). Male patients with anxiety, financial distress, and prior alcoholism/illicit drug use are significant predictors of ADB’s. A cut off score of ≥1 out 4 on CAGE-AID questionnaire allows better screening of ADB in outpatient advanced cancer patients. Further research to effectively manage these patients is needed.

scholarly journals Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center

Cancer ◽  
2011 ◽  
Vol 118 (15) ◽  
pp. 3869-3877 ◽  
Author(s):  
Shalini Dalal ◽  
David Hui ◽  
Linh Nguyen ◽  
Ray Chacko ◽  
Cheryl Scott ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Clinic

scholarly journals DEVELOPMENT OF AN OPIOID EDUCATION RESOURCE FOR OLDER CANCER PATIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S665-S666
Author(s):  
Ruth Manna ◽  
Natalie Moryl ◽  
Natalie Gangai ◽  
Vivek Malhotra ◽  
Jennifer Wang ◽  
...  
Keyword(s):  
Patient Education ◽  
Cancer Patients ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Additional Information ◽  
Open Questions ◽  
Older Cancer Patients ◽  
Education Resource

Abstract Pain is a common problem in older cancer patients, estimated to affect 70% of those with advanced disease. As older adults live longer after diagnosis, the use and misuse of opioids will continue to rise. Gaps in available age-friendly opioid resources for patients were identified at a Comprehensive Cancer Center. An interprofessional team worked to develop a resource to educate older cancer patients and their caregivers regarding safe opioid use. Expert clinical opinions from Supportive Care, Anesthesia Pain, Nursing, and Geriatrics Services as well as patient observations informed drafts of the resource. A total of 22 older patients in three geriatric clinics were approached for a short interview (8 open questions) surrounding opioid understanding and concerns. The most stated concerns were fear of addiction, concern about the opioid epidemic, and potential unwanted side effects. There was an evident lack of awareness of what an opioid was or which one of the medications in their list was an opioid. The interviews underscored the need for the education resource to include names of opioids, address concerns about the opioid epidemic and signs of addiction. Language was added to describe safe use, storage and disposal of opioids. Special considerations in the older adult were emphasized. Links to additional information were provided. Finally, patient education experts reviewed the draft to adapt the language to be patient-friendly. Opioids are often effectively used in cancer pain management and older cancer patients warrant proper education. Patient perspectives are critical in the development of relevant patient education resources.

Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

2016 ◽  
Vol 15 (6) ◽  
pp. 638-643 ◽  
Author(s):  
Julio Silvestre ◽  
Akhila Reddy ◽  
Maxine de la Cruz ◽  
Jimin Wu ◽  
Diane Liu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Education ◽  
Cancer Patients ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Pain Medications ◽  
The Impact ◽  
At Home

AbstractObjective:Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center.Method:We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids.Results:The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home.Significance of Results:Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.

Frequency and factors associated with falls in patients with advanced cancer presenting to an outpatient supportive care clinic

2014 ◽  
Vol 13 (2) ◽  
pp. 223-227 ◽  
Author(s):  
Meiko Kuriya ◽  
Sriram Yennurajalingam ◽  
Maxine Grace de la Cruz ◽  
Wei Wei ◽  
Shana Palla ◽  
...  
Keyword(s):  
Supportive Care ◽  
Advanced Cancer ◽  
Performance Status ◽  
Assistive Devices ◽  
Assessment Scale ◽  
Cancer Center ◽  
Care Clinic ◽  
Factors Associated ◽  
Edmonton Symptom Assessment Scale ◽  
Outpatient Supportive Care

AbstractObjective:The aim of this study was to determine the frequency and factors associated with fall episodes in advanced cancer patients.Method:We analyzed data that included demographic characteristics, utilization of assistive devices, cancer diagnosis, metastatic site, performance status, medications including hypnotics and opioids, Edmonton Symptom Assessment Scale (ESAS) score, and Memorial Delirium Assessment Scale (MDAS) score in 384 consecutive patients who were newly referred to the Supportive Care Clinic at the MD Anderson Cancer Center from January 1 to December 31, 2009. All patients completed standardized forms to report falls within the last month. Multivariate backward regression analyses were employed to identify factors predictive of falls in advanced cancer.Results:The mean age of patients was 58 years, and 192 (50%) were male. Mean (SD)/median score for pain was 5 (2.8), 5; fatigue 5.6 (2.6), 6; sleep disturbance 5(2.7), 5; drowsiness 3.7(3), 3; and anorexia 5(3), 5. Some 31 patients (8%) reported fall episodes within the past month, 17 (55%) of whom reported the use of assistive devices. Using assist devices (OR = 5.5, 95% CI: 2.6–11.9, p < 0.0001) and taking zolpidem (OR = 3.39, 95% CI: 1.39–7.7, p = 0.008) were associated with an enhanced chance of falling. Higher MDAS score (4.00 vs. 1.42, p = 0.001) and MDAS positive screening for delirium (21 vs. 3.6%, p < 0.001) were also associated with falls. However, severity on the ESAS at the initial consult was not associated with falls.Significance of Results:We conclude that 31 of 384 patients (8%) with advanced cancer receiving outpatient supportive care reported falls in the previous month. Patients with assistive devices, taking zolpidem, and with a higher MDAS score, and a positive delirium screening reported more frequent falls. Further studies are warranted.

Abstract D046: Supportive care needs in diverse cancer patients treated at a Comprehensive Cancer Center

2020 ◽  
Author(s):  
Kelsey Shore ◽  
Kathryn E. Weaver ◽  
Karen M. Winkfield ◽  
Janet A. Tooze ◽  
Carla Strom ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Supportive Care Needs ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Needs
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