Compassionate Care for People with Cancer and Opioid Use Disorder

"They still deserve for their pain to be controlled": healthcare providers' and community-level stakeholders' perceptions of pain management among cancer survivors with an opioid use disorder

PURPOSE

To explore healthcare providers' and community-level stakeholders' perceptions of opioid pain management among cancer survivors with a history of opioid use disorder living with cancer-related pain.

METHODS

Using a qualitative methodological approach, healthcare providers and community-level stakeholders providing care to cancer survivors with an opioid use disorder (OUD) were recruited by purposive sampling methods. Data was collected through semi-structured interviews that was subsequently transcribed verbatim and analyzed using thematic analysis.

RESULTS

Participants were healthcare providers (n = 24) and community-level stakeholders (n = 6). Four themes emerged from the data: (1) cancer survivors with an OUD deserve the right to adequate pain management, (2) healthcare professionals are uncomfortable providing pain management for cancer patients with OUD, (3) cancer survivors with cancer-related pain may suffer unnecessary pain for fear of violating their sobriety, and (4) perspectives on aberrant opioid-related behaviors among cancer survivors.

CONCLUSION

As opioid use disorder is becoming an increasing and co-present condition among patients with cancer, this study contributes important implications for improving care by understanding the views of healthcare providers and community-level stakeholders.

Care for patients with cancer and substance use disorders: a qualitative study of oncology team experiences

PURPOSE

Clinical decisions surrounding cancer care can be complicated by co-occurring substance use disorders (SUDs), particularly with respect to pain management and cancer treatment safety. Yet, few studies have examined oncology teams' experiences treating patients with co-occurring cancer and SUDs. We therefore sought to understand the perspectives of oncology team providers regarding the challenges they face when caring for patients with cancer and SUDs.

METHODS

We conducted a qualitative study to understand the experiences of clinicians who have provided cancer care to patients with concurrent SUD. Questions about substances used focused mainly on non-prescribed opioids and stimulants. Individual interviews were conducted in March-July 2023 by telephone or videoconference, recorded, transcribed verbatim, and analyzed rigorously using thematic analysis.

RESULTS

Twenty-seven individuals were interviewed (15 physicians, 8 advanced practice providers, 2 registered nurses, and 2 social workers). Specialties included medical oncology, hematology, radiation oncology, and gynecology oncology. We identified four themes representing the challenges oncology teams face when caring for patients with cancer and SUD: (1) patients' unmet social needs; (2) uncertainty about pain management options; (3) implicit biases about patients with SUDs; and( 4) patients' active substance use.

CONCLUSION

Oncology teams face many challenges when caring for patients with cancer and SUDs. Understanding these challenges is critical and can both inform the design of interventions for patients with cancer and SUD and guide future research.

How Racialized Approaches to Opioid Use Disorder and Opioid Misuse Management Hamper Pharmacoequity for Cancer Pain

@JCO_ASCO paper focuses on racialized approaches to OUD and opioid misuse as underappreciated drivers of disparities in cancer and recs a path forward.

Misuse of Prescribed and Nonprescribed Substances Among U.S. Cancer Survivors

BACKGROUND

Substance misuse is common among cancer survivors and can negatively impact cancer outcomes.

METHODS

We conducted a cross-sectional study using National Survey on Drug Use and Health data for 2015 to 2020. We included adult respondents with a history of solid tumor cancer. We calculated the weighted prevalence and corresponding SEs (both expressed as percentages) of substance (alcohol, opioid, sedative, stimulant, other) misuse for respondents with any history of solid tumor cancer and, in secondary analyses, respondents diagnosed with cancer in the prior 12 months.

RESULTS

The study included 6,101 respondents with any history of cancer, 1,437 diagnosed in the prior 12 months. Alcohol was the most commonly misused substance. The average prevalence of alcohol misuse was 14.4% (SE 0.60%) across cancer types; it was markedly more common among people with a history or cervical (24.2% [3.0%]) or head and neck cancer (27.4% [7.1%]). The next most common form of substance misuse was opioid misuse (average prevalence: 2.7% [0.25%]). As with alcohol misuse, the prevalence of opioid misuse was higher among those with a lifetime history of cervical cancer (5% [1%]) or head and neck cancer (5% [3%]). Results were generally consistent among cancer survivors diagnosed in the prior 12 months.

CONCLUSIONS

There is a clear opportunity to address substance misuse-particularly alcohol misuse-among cancer survivors. Such efforts should focus on populations with a high prevalence of substance misuse (e.g., cervical and head and neck cancer survivors) and have strong potential to improve cancer-specific and overall health outcomes.

Substance Use Disorder, Opioid Use Disorder, and Symptom Management in Palliative Care: A Rapid Review of Evidence

Substance use disorder (SUD) affects more than 1 in 6 Americans older than 12 years and has become an increasingly relevant topic in palliative care. Lack of clear guidelines and fragmented care results in patient safety concerns and poor outcomes. This rapid review aims to present the current literature on opioid contracts/agreements, prescription drug monitoring database access, opioid risk assessment tools, and urine drug screening in the palliative care setting. Through a systematic process, we identified 19 articles published between 2018 and 2023 that pertained to substance use disorder and palliative care. Current risk mitigation strategies include prescription drug monitoring, opioid use agreements, risk assessment tools, urine drug screening, and the use of buprenorphine to manage pain. Prescription drug monitoring programs are state-based electronic databases that track controlled substances, and there are numerous risk assessment tools. Urine drug screening involves the use of both immunoassay and confirmatory chromatography to determine the presence or absence of either the prescribed controlled substance or unexpected findings including illicit drugs or prescription-controlled substances that are not prescribed to the patient. The goal of mitigating risk and reducing harm while providing expert symptom management is the challenge that palliative care transdisciplinary teams face as they continue to care for patients with substance use disorder. This review points to the need for further research on how to incorporate these harm-reducing strategies into clinical practice.

Creating a Palliative Care Clinic for Patients with Cancer Pain and Substance Use Disorder

BACKGROUND

Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use.

MEASURES

Patient volume, 60-day retention rate, and use of sublingual buprenorphine to treat opioid use disorder.

INTERVENTION

We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry.

OUTCOMES

During the first 18 months, patient volume increased steadily; 70% of patients had at least one subsequent visit within 60 days of the initial appointment; and buprenorphine was prescribed for 55% of patients with opioid use disorder.

CONCLUSIONS/LESSONS LEARNED

The formal collaboration with addiction psychiatry and the integration of harm reduction principles and practices into ambulatory palliative care improved our ability to provide treatment to a previously underserved patient population with high symptom burden.