Yael Schenker1, Megan Hamm2, Hailey W Bulls1, Jessica S Merlin1, Rachel Wasilko2, Alicia Dawdani2, Balchandre Kenkre2, Shane Belin1, Lindsay M Sabik3. 1. Palliative Research Center (PaRC) and Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA. 2. Qualitative, Evaluation and Stakeholder Engagement Services (QualEASE), Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA. 3. Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Abstract
PURPOSE: Responses to the opioid epidemic in the United States, including efforts to monitor and limit prescriptions for noncancer pain, may be affecting patients with cancer. Oncologists' views on how the opioid epidemic may be influencing treatment of cancer-related pain are not well understood. METHODS: We conducted a multisite qualitative interview study with 26 oncologists from a mix of urban and rural practices in Western Pennsylvania. The interview guide asked about oncologists' views of and experiences in treating cancer-related pain in the context of the opioid epidemic. A multidisciplinary team conducted thematic analysis of interview transcripts to identify and refine themes related to challenges to safe and effective opioid prescribing for cancer-related pain and recommendations for improvement. RESULTS: Oncologists described three main challenges: (1) patients who receive opioids for cancer-related pain feel stigmatized by clinicians, pharmacists, and society; (2) patients with cancer-related pain fear becoming addicted, which affects their willingness to accept prescription opioids; and (3) guidelines for safe and effective opioid prescribing are often misinterpreted, leading to access issues. Suggested improvements included educational materials for patients and families, efforts to better inform prescribers and the public about safe and appropriate uses of opioids for cancer-related pain, and additional support from pain and/or palliative care specialists. CONCLUSION: Challenges to safe and effective opioid prescribing for cancer-related pain include opioid stigma and access barriers. Interventions that address opioid stigma and provide additional resources for clinicians navigating complex opioid prescribing guidelines may help to optimize cancer pain treatment.
PURPOSE: Responses to the opioid epidemic in the United States, including efforts to monitor and limit prescriptions for noncancer pain, may be affecting patients with cancer. Oncologists' views on how the opioid epidemic may be influencing treatment of cancer-related pain are not well understood. METHODS: We conducted a multisite qualitative interview study with 26 oncologists from a mix of urban and rural practices in Western Pennsylvania. The interview guide asked about oncologists' views of and experiences in treating cancer-related pain in the context of the opioid epidemic. A multidisciplinary team conducted thematic analysis of interview transcripts to identify and refine themes related to challenges to safe and effective opioid prescribing for cancer-related pain and recommendations for improvement. RESULTS: Oncologists described three main challenges: (1) patients who receive opioids for cancer-related pain feel stigmatized by clinicians, pharmacists, and society; (2) patients with cancer-related pain fear becoming addicted, which affects their willingness to accept prescription opioids; and (3) guidelines for safe and effective opioid prescribing are often misinterpreted, leading to access issues. Suggested improvements included educational materials for patients and families, efforts to better inform prescribers and the public about safe and appropriate uses of opioids for cancer-related pain, and additional support from pain and/or palliative care specialists. CONCLUSION: Challenges to safe and effective opioid prescribing for cancer-related pain include opioid stigma and access barriers. Interventions that address opioid stigma and provide additional resources for clinicians navigating complex opioid prescribing guidelines may help to optimize cancer pain treatment.
Authors: Robert A Swarm; Judith A Paice; Doralina L Anghelescu; Madhuri Are; Justine Yang Bruce; Sorin Buga; Marcin Chwistek; Charles Cleeland; David Craig; Ellin Gafford; Heather Greenlee; Eric Hansen; Arif H Kamal; Mihir M Kamdar; Susan LeGrand; Sean Mackey; M Rachel McDowell; Natalie Moryl; Lisle M Nabell; Suzanne Nesbit; Nina O'Connor; Michael W Rabow; Elizabeth Rickerson; Rebecca Shatsky; Jill Sindt; Susan G Urba; Jeanie M Youngwerth; Lydia J Hammond; Lisa A Gurski Journal: J Natl Compr Canc Netw Date: 2019-08-01 Impact factor: 11.908
Authors: Kurt Kroenke; Daniel P Alford; Charles Argoff; Bernard Canlas; Edward Covington; Joseph W Frank; Karl J Haake; Steven Hanling; W Michael Hooten; Stefan G Kertesz; Richard L Kravitz; Erin E Krebs; Steven P Stanos; Mark Sullivan Journal: Pain Med Date: 2019-04-01 Impact factor: 3.750