Barriers to Adequate Pain Control and Opioid Use Among Cancer Survivors: Implications for Nursing Practice

Direct Economic Burden of Post-Cancer Treatment Pain Among Cancer Survivors in the United States: A Population-Based Retrospective Longitudinal Study

PURPOSE

Post-cancer treatment pain (PCTP) is prevalent among cancer survivors but remains understudied. It is critical to quantify PCTP prevalence over time and to estimate the resulting short and long-term incremental healthcare expenditures (total, third-party, and out-of-pocket) and out-of-pocket burden among cancer survivors.

METHODS

A longitudinal retrospective cohort design was used. To identify cancer survivors (≥ 18 years) with PCTP, the Medical Expenditure Panel Survey (MEPS) and its supplementary Cancer Self-Administered Questionnaire (CSAQ)were used. Recycled predictions from generalised linear models (GLM) with log-link and gamma distribution were used to estimate annual incremental healthcare expenditures at different PCTP gradations over time. To account for covariate imbalance, sensitivity analysis using inverse probability weighting was conducted.

RESULTS

2125 cancer survivors had PCTP. Post-cancer treatment, 10.5%-24.2% of survivors experienced some form of chronic PCTP, whereas between 21.9%-5.1% experienced acute PCTP. Across the survivorship journey, the adjusted total annual incremental healthcare expenditures were the highest among cancer survivors with moderate chronic PCTP (< 1-year post-cancer treatment), and severe chronic PCTP, (≥ 5 years post-cancer treatment) compared to survivors with no pain, reaching respectively, $27.3 and $40.2 billion nationally. There was a significant high out-of-pocket burden among cancer survivors with severe chronic PCTP compared to those with no pain.

CONCLUSION

These findings highlight the persistent financial burden of PCTP but also the critical need for effective pain management alongside the use of patient-reported outcomes for pain among cancer survivors.

Patient-Related Barriers to Chronic Pain Management Among Cancer Survivors: A Narrative Synthesis

Purpose : Cancer survivors often experience chronic pain, impacting their daily functioning and quality of life. Despite the existence of effective pain management therapies, cancer survivors may not experience adequate pain management related to patient-related barriers. This review aims to explore the patient-related barriers that inhibit effective chronic pain management among cancer survivors. Methods : A narrative synthesis was conducted using a systematic review of the literature. Abstract and full-text screening, along with quality appraisal and level of evidence assessments, were conducted. Data was extracted on each study's approach, methods, results, and implications, and thematic analysis was used to synthesize the findings. Results : A total of 330 participants were included in the 11 papers reviewed. General barriers to chronic pain management included a lack of preparedness for chronic pain, negative perceptions toward chronic pain, and poor patient-provider communication. Opioid-specific barriers were identified and included opioid use disorder stigma, knowledge deficits about opioid-related terms, and undesirable side effects. Physical activity barriers included logistical considerations, symptom-related restrictions, and cognitive challenges. Conclusions : Patient-related barriers to chronic pain management among cancer survivors include general, opioid-related, and physical activity-related barriers. Among these, the most significant barriers were negative perceptions toward chronic pain, inadequate patient-provider communication, opioid-related stigma, undesirable side effects of opioids, and symptom-related barriers to physical activity. Implications : Healthcare providers, cancer survivors, and caregivers require more education on communication techniques, the biopsychosocial model of pain, and opioid use disorder. Social support interventions could also be developed to promote engagement in physical activity among cancer survivors.

Opioid use in cancer patients compared with noncancer pain patients in a veteran population

BACKGROUND

Opioid safety initiatives may secondarily impact opioid prescribing and pain outcomes for cancer care.

METHODS

We reviewed electronic health record data at a tertiary Veterans Affairs system (VA Palo Alto) for all patients from 2015 to 2021. We collected outpatient Schedule II opioid prescriptions data and calculated morphine milligram equivalents (MMEs) using Centers for Disease Control and Prevention conversion formulas. To determine the clinical impact of changes in opioid prescription, we used the highest level of pain reported by each patient on the 0-to-10 Numeric Rating Scale in each year, categorized into mild (0-3), moderate (4-6), and severe (7 and above).

RESULTS

Among 89 569 patients, 9073 had a cancer diagnosis. Cancer patients were almost twice as likely to have an opioid prescription compared with noncancer patients (69.0% vs 36.7%, respectively). The proportion of patients who received an opioid prescription decreased from 27.1% to 18.1% (trend P < .01) in cancer patients and from 17.0% to 10.2% in noncancer patients (trend P < .01). Cancer and noncancer patients had similar declines of MMEs per year between 2015 and 2019, but the decline was more rapid for cancer patients (1462.5 to 946.4, 35.3%) compared with noncancer patients (1315.6 to 927.7, 29.5%) from 2019 to 2021. During the study period, the proportion of noncancer patients who experienced severe pain was almost unchanged, whereas it increased among cancer patients, reaching a significantly higher rate than among noncancer patients in 2021 (31.9% vs 27.4%, P < .01).

CONCLUSIONS

Our findings suggest potential unintended consequences for cancer care because of efforts to manage opioid-related risks.