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Yusufov M, Melanson SEF, Kang P, Kematick B, Schiff GD, Chua IS. Clinician Ordering and Management Patterns of Urine Toxicology Results at a Cancer Center. J Pain Symptom Manage 2024; 68:e36-e45. [PMID: 38599533 DOI: 10.1016/j.jpainsymman.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
CONTEXT Opioid therapy is a cornerstone for treatment of cancer-related pain, but standardized management practices for patients with cancer and aberrant urine drug test (UDT) results are lacking. OBJECTIVES To identify the prevalence of UDT ordering (both screening and definitive testing) in the oncology setting and to examine clinician management practices for patients with cancer on opioid therapy with aberrant definitive UDT results. METHODS We conducted a retrospective chart review of patients with cancer on opioid therapy at an academic cancer center in the United States. Outcomes included UDT ordering patterns and clinician management practices in response to aberrant definitive UDT results. RESULTS Our study revealed an overall UDT ordering rate of 3.7% among 10,371 patients with cancer on opioid therapy. Among 143 patients for whom definitive UDTs were ordered, oncologists only ordered 14 (9.8%) UDTs, while palliative care ordered the majority (n = 129; 90.2%). Fifty-five (38.5%) patients had aberrant results, and the most common aberrancy was presence of illicit drugs 22 [15.4%]. Clinicians rarely made medication changes (20 [36.4%]) when UDT results were aberrant, and in the setting of possible fentanyl use (n = 8), only 3 (37.5%) patients were started/switched to methadone, and none were started/switched to buprenorphine. CONCLUSION Overall UDT ordering was infrequent for patients with cancer on opioid therapy, especially by oncologists, and clinicians rarely made prescribing changes when definitive UDT results were aberrant. More definitive guidance related to UDT ordering and opioid management are needed for patients with cancer and aberrant UDT results.
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Affiliation(s)
- Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care (M.Y., B.K., I.S.C.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (M.Y., S.E.F.M., G.D.S., I.S.C.), Boston, Massachusetts, USA
| | - Stacy E F Melanson
- Department of Pathology (S.E.F.M., P.K.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (M.Y., S.E.F.M., G.D.S., I.S.C.), Boston, Massachusetts, USA
| | - Phillip Kang
- Department of Pathology (S.E.F.M., P.K.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin Kematick
- Department of Psychosocial Oncology and Palliative Care (M.Y., B.K., I.S.C.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gordon D Schiff
- Center for Patient Safety Research and Practice (G.D.S.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Medicine (G.D.S., I.S.C.), Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (M.Y., S.E.F.M., G.D.S., I.S.C.), Boston, Massachusetts, USA; Harvard Medical School Center for Primary Care (G.D.S.), Boston, Massachusetts, USA
| | - Isaac S Chua
- Department of Psychosocial Oncology and Palliative Care (M.Y., B.K., I.S.C.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine (G.D.S., I.S.C.), Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (M.Y., S.E.F.M., G.D.S., I.S.C.), Boston, Massachusetts, USA.
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Halphen JM, Arthur JA, Pacheco S, Nguyen LMT, Samy NN, Wilson NR, Sattler G, Wing SE, Paulino RAD, Feng C, Shah P, Olayiwola S, Cannell B, Addimulam S, Patel R, Hui D. Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic. Cancers (Basel) 2023; 15:5663. [PMID: 38067365 PMCID: PMC10705126 DOI: 10.3390/cancers15235663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. OBJECTIVES We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. METHODS A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. RESULTS Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03-4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78-7.13; p < 0.001), and history of marijuana use (OR = 7.05; CI: 3.85-12.91; p < 0.001) were independent predictors of an aberrant UDT finding. CONCLUSION Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings.
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Affiliation(s)
- John M. Halphen
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, UTHealth, Houston, TX 77030, USA; (S.P.); (L.M.T.N.); (S.O.)
| | - Joseph A. Arthur
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA; (J.A.A.); (D.H.)
| | - Soraira Pacheco
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, UTHealth, Houston, TX 77030, USA; (S.P.); (L.M.T.N.); (S.O.)
| | - Linh M. T. Nguyen
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, UTHealth, Houston, TX 77030, USA; (S.P.); (L.M.T.N.); (S.O.)
| | - Nikitha N. Samy
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Nathaniel R. Wilson
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Gregory Sattler
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Shane E. Wing
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Rex A. D. Paulino
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Christine Feng
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Pulin Shah
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA (N.R.W.); (G.S.); (S.E.W.); (R.A.D.P.)
| | - Simbiat Olayiwola
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, UTHealth, Houston, TX 77030, USA; (S.P.); (L.M.T.N.); (S.O.)
| | - Bradley Cannell
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (B.C.); (S.A.); (R.P.)
| | - Supriyanka Addimulam
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (B.C.); (S.A.); (R.P.)
| | - Riddhi Patel
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (B.C.); (S.A.); (R.P.)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA; (J.A.A.); (D.H.)
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