Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era

2019 ◽  
pp. 24-35 ◽  
Author(s):  
Shalini Dalal ◽  
Eduardo Bruera
Keyword(s):  
At Risk ◽  
Advanced Cancer ◽  
Treatment Plan ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Patients With Cancer ◽  
Assessment And Treatment ◽  
The Face ◽  
Risk Patients

Use of opioids for the treatment of pain is necessary for the majority of patients with advanced cancer, however its use has become challenging in the face of the opioid epidemic and the emerging evidence that patients with cancer are also at risk for nonmedical opioid use. This article proposes an assessment and treatment plan that incorporates universal screening with monitoring for all patients with cancer who are considered for opioid treatment to assess their risk for opioid misuse and harm. Timely identification with appropriate management, including referral of at-risk patients, will allow oncology professionals to optimize the risk-to-benefit and support the safe use of opioids for patients with cancer.

Meaning-Centered Psychotherapy

2021 ◽  
pp. 489-494
Author(s):  
Melissa Masterson Duva ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
William S. Breitbart
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Psychosocial Care ◽  
Well Being ◽  
Cancer Center ◽  
Existential Psychology ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

scholarly journals Addressing the Opioid Epidemic: Recommended Solutions from Physicians

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jessica Cataldo ◽  
Sandra Collins ◽  
Richard C Mckinnies ◽  
Jane Nichols ◽  
Thomas A Shaw
Keyword(s):  
United States ◽  
Active Role ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multifaceted Approach ◽  
Improve Treatment ◽  
Opioid Crisis ◽  
A Current

The purpose of this study was to assess physicians’ accounts related to the current opioid epidemic and to identify solutions that they feel would be most successful in addressing opioid misuse and overuse. A survey was administered a group of physicians obtained from a nationwide database. Nearly all physicians surveyed believed there was a current opioid crisis in the United States and that physicians should take an active role in addressing opioid use in patients. Four key themes emerged regarding solutions to the opioid crisis: i) policy change, ii) improve treatment, iii) education, and iv) alternative treatment. The diversity of responses highlighted the need for a multifaceted approach to address opioid misuse and abuse.

scholarly journals The Opioid Epidemic: Misuse, Tolerance and Addiction

2020 ◽  
pp. 01-02
Author(s):  
Olivia Xu ◽  
Jingping Wang
Keyword(s):  
Human Services ◽  
Public Health Emergency ◽  
Pharmaceutical Companies ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Health And Human Services ◽  
Department Of Health ◽  
Rising Incidence ◽  
The U.S

In 2017, the U.S. Department of Health and Human Services declared what became known as the opioid crisis, to be a public health emergency. The origin of this epidemic dates back to the 1990s, where pharmaceutical companies initially began reassuring medical professionals that prescribing opioid pain relievers would pose no risk to patients in need. Subsequently, providers began to gradually administer opioids in greater doses, which eventually resulted in widespread misuse of the drug. When it finally became clear that opioids could become dangerously addictive, it was already too late. “Devastating consequences of the opioid epidemic include increases in opioid misuse and related overdoses, as well as the rising incidence of newborns experiencing withdrawal syndrome due to opioid use and misuse during pregnancy” [1]. Today, an average of over 130 U.S. citizens die every day due to misuse and overdosing on opioids. Keywords: Opioids epidemic; Tolerance; Misuse; Addiction

scholarly journals Opioid disposal rates after spine surgery

2021 ◽  
Vol 12 ◽  
pp. 472
Author(s):  
Susanna Davis Howard ◽  
Anish Agarwal ◽  
Kit Delgado ◽  
Edward Rodriguez-Caceres ◽  
Disha Joshi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Spine Surgery ◽  
Text Messaging ◽  
Telephone Survey ◽  
Median Number ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Urban University

Background: Diversion of prescription opioids pills is a significant contributor to opioid misuse and the opioid epidemic. The goal of this study was to determine the frequency and quantity of excess opioid pills among patients undergoing spine surgery. Further, we wanted to determine the frequency of appropriate opioid disposal. Methods: This was a prospective cohort study of patients undergoing elective spine surgery within a multi-hospital, academic, urban university health system enrolled in a text-messaging program used to track postoperative opioid disposal. Patients who self-reported discontinuation of opioid use but with leftover pills were contacted via telephone and surveyed on opioid disposal. Results: Of the 291 patients who enrolled in the text-messaging program, 192 (66%) patients reported discontinuing opioids within 3 months of surgery. Although 76 (40%) reported excess opioid pills after cessation of use, only 47 (62%) participated in the telephone survey regarding opioid disposal. The median number of leftover pills among these 47 patients was 5 (5, 15) and 64% had not disposed of their prescription. Conclusion: Among the 47 telephone survey participants, a persistent gap remained in postoperative opioid excess and improper disposal. Future efforts must focus on initiatives to improve opioid disposal rates to reduce the quantity of opioids at risk for diversion and to reduce excess prescribing.

scholarly journals Opioid Epidemic or Pain Crisis? Using the Virginia All Payer Claims Database to Describe Opioid Medication Prescribing Patterns and Potential Harms for Patients With Cancer

2019 ◽  
Vol 15 (12) ◽  
pp. e997-e1009 ◽  
Author(s):  
Virginia T. LeBaron ◽  
Fabian Camacho ◽  
Rajesh Balkrishnan ◽  
Nengliang (Aaron) Yao ◽  
Aaron M. Gilson
Keyword(s):  
Essential Element ◽  
The United States ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Opioid Medication ◽  
Claims Database ◽  
Patients With Cancer ◽  
Controlled Substance

PURPOSE: A key challenge regarding the current opioid epidemic is understanding how concerns regarding opioid-related harms affect access to pain management, an essential element of cancer care. In certain regions of the United States where disproportionately high cancer mortality and opioid fatality rates coexist (such as southwest Virginia in central Appalachia), this dilemma is particularly pronounced. METHODS: This longitudinal, exploratory, secondary analysis used the Commonwealth of Virginia All Payer Claims Database to describe prescription opioid medication (POM) prescribing patterns and potential harms for adult patients with cancer living in rural southwest Virginia between 2011 and 2015. Descriptive and inferential statistical analyses were conducted at the patient, prescriber, and prescription levels to identify patterns and predictors of POM prescribing and potential harms. To explore geographic patterns, choropleth and heat maps were created. RESULTS: Of the total sample of patients with cancer (n = 4,324), less than 25% were prescribed a Controlled Substance Schedule II POM at least three times in any study year. More than 60% of patients never received a Controlled Substance Schedule II POM prescription. Six hundred fifty-two patients (15.1%) experienced 1,599 hospitalizations for any reason; 10 or fewer patients were admitted for 11 opioid use disorder–related hospitalizations. The main findings suggest potential undertreatment of cancer-related pain; no difference in risk for opioid-related hospitalization on the basis of frequency of POM prescriptions; and geographic disparities where opioid overdoses are occurring versus where POM prescription use is highest. CONCLUSION: These findings have significant opioid policy and practice implications related to the need for cancer-specific prescribing guidelines, how to optimally allocate health delivery services, and the urgent need to improve data interoperability and access related to POMs.

Evidence-Based Recommendations for Cancer Fatigue, Anorexia, Depression, and Dyspnea

2008 ◽  
Vol 26 (23) ◽  
pp. 3886-3895 ◽  
Author(s):  
Sydney M. Dy ◽  
Karl A. Lorenz ◽  
Arash Naeim ◽  
Homayoon Sanati ◽  
Anne Walling ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Treatment Effectiveness ◽  
Treatment Plan ◽  
Evidence Based ◽  
Initial Visit ◽  
Patients With Cancer ◽  
Associated Symptoms ◽  
Hastened Death ◽  
Underlying Causes

Purpose The experience of patients with cancer often involves symptoms of fatigue, anorexia, depression, and dyspnea. Methods We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Results For fatigue, providers should screen patients at the initial visit, for newly identified advanced cancer, and at chemotherapy visits; assess for depression and insomnia in newly identified fatigue; and follow up after treatment for fatigue or a secondary cause. For anorexia, providers should screen at the initial visit for cancer affecting the oropharynx or gastrointestinal tract or advanced cancer, evaluate for associated symptoms, treat underlying causes, provide nutritional counseling for patients undergoing treatment that may affect nutritional intake, and follow up patients given appetite stimulants. For depression, providers should screen newly diagnosed patients, those started on chemotherapy or radiotherapy, those with newly identified advanced disease, and those expressing a desire for hastened death; document a treatment plan in diagnosed patients; and follow up response after treatment. For general dyspnea, providers should evaluate for causes of new or worsening dyspnea, treat or symptomatically manage underlying causes, follow up to evaluate treatment effectiveness, and offer opioids in advanced cancer when other treatments are unsuccessful. For dyspnea and malignant pleural effusions, providers should offer thoracentesis, follow up after thoracentesis, and offer pleurodesis or a drainage procedure for patients with reaccumulation and dyspnea. Conclusion These standards provide a framework for evidence-based screening, assessment, treatment, and follow-up for cancer-associated symptoms.

scholarly journals Potentially Inappropriate Use of Intravenous Opioids in Hospitalized Patients

2019 ◽  
Vol 14 (11) ◽  
pp. 678-680
Author(s):  
Amber B Moore ◽  
Scott Navarrett ◽  
Shoshana J Herzig
Keyword(s):  
Medical Center ◽  
Hospital Medicine ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Gastrointestinal Dysfunction ◽  
Comfort Care ◽  
Inappropriate Use ◽  
Patients With Cancer ◽  
Appropriate Prescribing

Physicians have the potential to decrease opioid misuse through appropriate prescribing practices. We examined the frequency of potentially inappropriate intravenous (IV) opioid use (where oral use would have been more appropriate) in patients hospitalized at a tertiary medical center. We excluded patients with cancer, patients receiving comfort care, and patients with gastrointestinal dysfunction. On the basis of recent guidance from the Society of Hospital Medicine, we defined IV doses as potentially inappropriate if administered more than 24 hours after an initial IV dose in patients who did not have nil per os status. Of the 200 patients studied, 31% were administered potentially inappropriate IV opioids at least once during their hospitalization, and 33% of all IV doses administered were potentially inappropriate. Given the numerous advantages of oral over IV opioids, this study suggests significant potential for improving prescribing practices to decrease risk of addiction, costs, and complications, ultimately improving the value of care provided.

scholarly journals Fit for Cancer Treatment: a prospective feasibility study of primary care initiated prehabilitation for patients with suspected cancer

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101608
Author(s):  
Rachael C Barlow ◽  
David Sheng Yi Chan ◽  
Sharon Mayor ◽  
Ceri Perkins ◽  
Helen L Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Treatment Plan ◽  
Curative Treatment ◽  
Healthcare Intervention ◽  
Study Cohort ◽  
Patients With Cancer ◽  
Care Assessment ◽  
Assessment And Treatment ◽  
Pre Treatment

BackgroundRisk profile assessment and corrective interventions using optimisation of health status and prehabilitation represent an important strategy in the management of patients with a suspected cancer diagnosis.AimTo determine the feasibility of pre-treatment optimisation and prehabilitation commenced at index primary care consultation, to improve patients’ preparation for treatment by maximising the time available.Design & settingBetween January 2015 and May 2016, 195 patients presenting to 12 GP practices were deemed eligible to enter the study, of which 189 (96.9%, median age 60 [21–91] years and 65 months; 124 female) were recruited and consented to the prehabilitation bundle.MethodAll patients were simultaneously referred to secondary care using urgent suspected cancer (USC) pathways. The primary outcome measures were definitive diagnosis and treatment plan.ResultsFifteen patients (7.9%) were diagnosed with cancer (three breast, three colon, two lung, two skin [one melanoma, one sarcoma], one tonsil, one vocal cord, one pancreas, one prostate, one ependymoma) and 62 were diagnosed with other significant medical conditions (47 gastrointestinal, 13 sepsis, two respiratory) requiring secondary care assessment and treatment. Of the 15 patients with cancer, 11 (73.3%) underwent potentially curative treatment, and four (26.7%) palliative treatment. Of the total study cohort, 84 (44%) required a form of optimisation in primary care, and patients with cancer were more likely to require optimisation than others (n = 10 [63%] versus n = 74 [43%], χ2 9.384, P = 0.002).ConclusionOne in 12 primary care USC patients had cancer (5.6% receiving potentially curative treatment), one in three had other systemic health issues, and overall two in five benefited from healthcare intervention. Primary care optimisation was feasible and associated with important allied health benefits.

scholarly journals Curbing the Opioid Epidemic at Its Root: The Effect of Provider Discordance After Opioid Initiation

2022 ◽  
Author(s):  
Katherine Bobroske ◽  
Michael Freeman ◽  
Lawrence Huan ◽  
Anita Cattrell ◽  
Stefan Scholtes
Keyword(s):  
Primary Care ◽  
Causal Effect ◽  
Care Delivery ◽  
Treatment Plan ◽  
Healthcare Management ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Instrumental Variable Analysis

Although medical research has addressed the clinical management of chronic opioid users, little is known about how operational interventions shortly after opioid initiation can impact a patient’s likelihood of long-term opioid use. Using a nationwide U.S. database of medical and pharmaceutical claims, we investigate the care delivery process at the most common entry point to opioid use: the primary care setting. For patients who return to primary care for a follow-up appointment within 30 days of opioid initiation, we ask who should revisit and potentially revise the opioid-based treatment plan: the initial prescriber (provider concordance) or an alternate clinician (provider discordance)? First, using a fully controlled logistic model, we find that provider discordance reduces the likelihood of long-term opioid use 12 months after opioid initiation by 31% (95% Confidence Interval: [18%, 43%]). Both the instrumental variable analysis technique and propensity-score matching (utilizing the minimum-bias estimator approach) account for omitted variable bias and indicate that this is a conservative estimate of the true causal effect. Second, looking at patient activities immediately after the follow-up appointment, we find that this long-term reduction is at least partially explained by an immediate reduction in opioids prescribed after the follow-up appointment. Third, the data suggest that the benefit associated with provider discordance remains significant regardless of whether the patient’s initial prescriber was their regular primary care provider or another clinician. Overall, our analysis indicates that systematic, operational changes in the early stages of managing new opioid patients may offer a promising, and hitherto overlooked, opportunity to curb the opioid epidemic. This paper was accepted by David Simchi-Levi, healthcare management.

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