Centers for Disease Control and Prevention Guidelines on Opioid Use for Cancer Pain

TOP - August 2017, Vol 10, No 3 - Conference Correspondent, HOPA 2017 Highlights
Chase Doyle

Anaheim, CA—The United States may be in the midst of an opioid epidemic, but the undertreatment of pain remains an issue for patients with cancer. US healthcare providers wrote 259 million prescriptions for opioids in 2012, enough for every adult in the country, but approximately 50% of patients with cancer continue to report pain (van den Beuken-van Everdingen MH, et al. Ann Oncol. 2007;18:1437-1449), said Julie Waldfogel, PharmD, CPE, Clinical Pharmacy Specialist, Pain and Palliative Care, Johns Hopkins Hospital, Baltimore, MD, at the 2017 Hematology/Oncology Pharmacy Association Annual Conference, who cited a 2007 study by van den Beuken-van Everdingen and colleagues.

This pain does not end with the disease. In the same study, 33% of cancer survivors reported dealing with constant pain after curative treatment.

To help grapple with these contradictions, Dr Waldfogel focused on the recent Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain. The CDC guidelines specifically exclude patients with cancer who are receiving active treatment, palliative care, or end-of-life care. Only cancer survivors with chronic pain who have completed treatment, who are in clinical remission, or who are under cancer surveillance are included in the guidelines.

Educate Patients on Risks and Benefits of Therapy

It is important to educate patients about the risks and benefits of opioid use before starting opioid therapy, but provider responsibilities should be considered as well, said Dr Waldfogel. For patients receiving long-term opioid therapy, multiple groups recommend the use of treatment agreements—a document signed by the patient and the clinician that outlines the responsibilities and expectations of both parties.

However, the effectiveness of these agreements is equivocal, said Dr Waldfogel. Although primary care providers report improved satisfaction and comfort in managing patients with chronic pain when using treatment agreements, a systematic review revealed weak evidence supporting the effectiveness of opioid treatment agreements in reducing opioid misuse (Starrels JL, et al. Ann Intern Med. 2010;152:712-720).

“Most studies that have evaluated effectiveness say they simply make providers feel better about themselves,” said Dr Waldfogel. “Don’t ask patients to sign a treatment agreement as part of general paperwork. Instead, talk to patients separately about the contract, and use it as an opportunity to provide education,” she advised.

Risk Screening Tools

The CDC also recommends that providers evaluate risk factors for opioid-related harms and mitigate such risk. There are several risk screening tools available to screen patients before and during opioid treatment.

“These tools are not time-consuming, ranging from 3 minutes to 15 minutes or less, but can be useful as a part of risk stratification,” said Dr Waldfogel, who stressed that the point of risk stratifying is to “do something different based on which strata your patients are in.”

“Reassessment is essential as a patient’s risk stratification can change over time,” she added.

Additional Recommendations

In addition, the CDC recommends reviewing prescriptions with Prescription Drug Monitoring Programs, which are statewide electronic databases on controlled substance dispensing. These are only state-specific, said Dr Waldfogel, but legislation is progressing for states to share these data.

Finally, per the CDC, providers should use urine drug testing before starting opioids and at least annually, she said.

“You don’t need to apply all of these ideas, but be open to the idea that some of these will apply,” concluded Dr Waldfogel.

Related Items
Emerging Safety Data with Checkpoint Inhibitors
Phoebe Starr
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Conference Correspondent
Psychological Distress in Patients with Cancer Warrants Attention
Phoebe Starr
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Conference Correspondent
Patients’ Chemotherapy-Related Side-Effect Concerns Have Evolved, But Hair Loss Remains Significant
Phoebe Starr
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Conference Correspondent
Increased Cancer Risk in Postmenopausal Women with Central Obesity
Phoebe Starr
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Conference Correspondent
Patients’ Fears of Radiation Side Effects Largely Unfounded
Phoebe Starr
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Conference Correspondent
Netupitant plus Palonosetron Noninferior to Aprepitant plus Granisetron in Patients Receiving Highly Emetogenic Chemotherapy
Li Zhang, MD
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Conference Correspondent
Daratumumab Added to Carfilzomib, Lenalidomide, and Dexamethasone: Safe and Tolerable in Patients with Newly Diagnosed Multiple Myeloma
Chase Doyle
TOP - November 2017, Vol 10, No 4 published on November 13, 2017 in Multiple Myeloma
Patient-Reported Outcomes Influence Radiation Guidelines
Alice Goodman
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Conference Correspondent
Healthy Lifestyle Improves Survival in Patients with Colon Cancer
Phoebe Starr
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Colorectal Cancer, Conference Correspondent
8-Week Internet-Based Psychological Intervention Reduces Stress in Patients Newly Diagnosed with Cancer
Phoebe Starr
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Conference Correspondent
Last modified: August 2, 2017