Developing Best Practices to Mitigate Opioid Abuse Is a Priority in Cancer Care

Karen Hande, DNP, ANP-BC, CNE, and M. Rachel McDowell, ANCP-BC
Published: Monday, Jul 23, 2018
vanderbilt-cancer-centerKaren Hande, DNP, ANP-BC, CNE
Karen Hande, DNP, ANP-BC, CNE
Associate Professor of Nursing,
Vanderbilt University School of Nursing
Supportive Oncology Clinic,
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee
M. Rachel McDowell, ANCP-BC
M. Rachel McDowell, ANCP-BC
Supportive Oncology Clinic
Vanderbilt-Ingram Cancer Center,
Nashville, Tennessee
Strategic Partnership
Most patients with cancer experience pain during their journey: 55% during treatment; 66.4% during advanced, metastatic, or terminal disease stages; and 39.3% after curative treatment.1 Opioids are prescribed to manage cancer pain because the benefits generally outweigh the risks and because of the ethical imperative for quick relief.2 However, although opioids relieve cancer pain, patients are exposed to a degree of risk for misuse and abuse.3 Even with the appropriate management of cancer pain, the possibility of misuse, abuse, addiction, and diversion exists.4

Safe prescribing of opioids must be the cornerstone of practice for every prescriber.5 Several societies provide clinical guidelines to reduce the risk of misuse and abuse.6-8 The FDA’s Risk Evaluation and Mitigation Strategy (REMS) program details prescriber duties for management of pain with opioids.9 National Comprehensive Cancer Network (NCCN) guidelines describe the application of REMS for patients with cancer and outline strategies to identify patients’ potential for opioid misuse and abuse.5 However, guidelines from professional organizations that specifically address the assessment and management of opioid-use disorder for patients with cancer are lacking.10

Prescribers must consider multiple ways to screen and monitor for aberrant behavior among patients with cancer who receive opioids.9 At Vanderbilt-Ingram Cancer Center, we use the following strategies in our Supportive Oncology Care Clinic based on best evidence and recommendations (Table).

Table. A Framework for Managing Opioid use in Patients With Cancer Pain

Table. A Framework for Managing Opioid use in Patients With Cancer Pain

Universal Precautions

Universal precautions, the current approach to screening and monitoring patients who receive opioid therapy, require interventions and diagnostic tools to assess risk and monitor patients for aberrant behavior.

Initial Risk Assessment

The NCCN Guidelines for Adult Cancer Pain recommend an evaluation of patient risk factors for aberrant use of opioids prior to prescribing opioid therapy.5 Both a sensitive screening tool and comprehensive interview should be used to obtain patient-reported information related to previous and current status of mental health, sexual abuse, substance abuse, social functioning, and family history.10 The guidelines suggest using the revised Screener and Opioid Assessment for Patients with Pain11 tool or Opioid Risk Tool.12

View Conference Coverage
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Rapid Reviews in Oncology®: Practice-Changing Data in Acute Myeloid Leukemia: A Rapid Update From Atlanta OnlineDec 21, 20182.0
Community Practice Connections™: 2nd Annual European Congress on Hematology™: Focus on Lymphoid MalignanciesDec 30, 20182.0
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