Perceptions of prescription opioid medication within the context of cancer survivorship and the opioid epidemic

Abstract

Purpose

Prescription opioid medication can be of great benefit for cancer patients and survivors who suffer from cancer-related pain throughout their cancer care trajectory. However, the current opioid epidemic has influenced how such medications are perceived. The purpose of this study was to explore the perceptions of opioid use and misuse in cancer survivorship within the context of the opioid epidemic.

Methods

pt?>A qualitative study using a semi-structured interview was conducted with a purposive sample of health care professionals (n = 24), community-level stakeholders (n = 6), and cancer survivors (n = 25) using applied thematic analysis techniques.

Results

Crosscutting themes include (1) fear of addiction and living with poorly managed pain, (2) the importance of good patient/provider communication and the need for education around the use/handling/disposal of prescription opioid medication, (3) preference for nonopioid alternatives for pain management, (4) cancer survivors perceived to be low risk for developing opioid use disorder (include inconsistent screening), and (5) impact of policies aimed at curbing the opioid epidemic on cancer survivors.

Conclusion

This study illustrates the intersecting and sometimes conflicting assumptions surrounding the use of opioids analgesics in the management of cancer pain among survivors embedded within the national discourse of the opioid epidemic.

Implications for Cancer Survivors

A system of integrated cancer care using psychosocial screening, opioid risk mitigation tools, opioid treatment agreements, and specialist expertise that cancer care providers can rely on to monitor POM use in conjunction with patient-centered communication to empower patients informed decision making in managing their cancer pain could address this critical gap in survivorship care.

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References

  1. 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363–85.

    Article  Google Scholar 

  3. 3.

    Walling AM, Weeks JC, Kahn KL, Tisnado D, Keating NL, Dy SM, et al. Symptom prevalence in lung and colorectal cancer patients. J Pain Symptom Manag. 2015;49(2):192–202.

    Article  Google Scholar 

  4. 4.

    Brown MR, Ramirez JD, Farquhar-Smith P. Pain in cancer survivors. Br J Pain. 2014;8(4):139–53.

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Jiang C, Wang H, Wang Q, Luo Y, Sidlow R, Han X. Prevalence of chronic pain and high-impact chronic pain in cancer survivors in the United States. JAMA oncology. 2019;5(8):1224–6.

    PubMed Central  Article  PubMed  Google Scholar 

  6. 6.

    Reis-Pina P, Lawlor PG, Barbosa A. Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic. J Pain Res. 2017;10:2097–107.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Handberg C, Jensen CM, Maribo T. Lack of needs assessment in cancer survivorship care and rehabilitation in hospitals and primary care settings. J of Clin Med Res. 2017;9(10):864–71.

    Article  Google Scholar 

  8. 8.

    Adam R, de Wit N, Groome P, Helsper C, McBride M, Watson E, et al. Increased survival means increasing roles for primary care after cancer diagnosis. Br J Gen Pract. 2017;67(661):349.

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Oldenmenger WH, Smitt PAS, van Dooren S, Stoter G, van der Rijt CC. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45(8):1370–80.

    PubMed  Article  Google Scholar 

  10. 10.

    Sun V, Borneman T, Piper B, Koczywas M, Ferrell B. Barriers to pain assessment and management in cancer survivorship. J Cancer Surviv. 2008;2(1):65–71.

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Ward SE, Goldberg N, Miller-McCauley V, Mueller C, Nolan A, Pawlik-Plank D, et al. Patient-related barriers to management of cancer pain. Pain. 1993;52(3):319–24.

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin. 2011;61(3):157–82.

    PubMed  Article  Google Scholar 

  13. 13.

    Jacobsen R, Liubarskienë Z, Møldrup C, Christrup L, Sjøgren P, Samsanavičienë J. Barriers to cancer pain management: a review of empirical research. Medicina. 2009;45(6):427.

    PubMed  Article  Google Scholar 

  14. 14.

    Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps. BJA: Br J Anaesth. 2017;119(4):723–36.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Carmona-Bayonas A, Jiménez-Fonseca P, Castañón E, Ramchandani-Vaswani A, Sánchez-Bayona R, Custodio A, et al. Chronic opioid therapy in long-term cancer survivors. Clin Transl Oncol. 2017;19(2):236–50.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Vitzthum LK, Riviere P, Sheridan P, Nalawade V, Deka R, Furnish T, et al. Predicting persistent opioid use, abuse, and toxicity among cancer survivors. JNCI: J Nat Cancer Inst. 2020;112(7):720–7.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Greene MS, Chambers RA. Pseudoaddiction: fact or fiction? An investigation of the medical literature. Current addiction reports. 2015;2(4):310–7.

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Michener L, Cook J, Ahmed SM, Yonas MA, Coyne-Beasley T, Aguilar-Gaxiola S. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. Acad Med. 2012;87(3):285–91.

    PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Bernard RH. Research methods in anthropology: Qualitative and quantitative approaches. Rowman & Littlefield. 2017.

  20. 20.

    Patton M. Purposeful sampling and case selections: overview of strategies and options. Qual Res Evaluation Methods. 2015:264–315.

  21. 21.

    Denlinger CS, Carlson RW, Are M, Baker KS, Davis E, Edge SB, et al. Survivorship: introduction and definition. J Natl Compr Cancer Netw. 2014;12(1):34–45.

    Article  Google Scholar 

  22. 22.

    Sim J, Saunders B, Waterfield J, Kingstone T. Can sample size in qualitative research be determined a priori? Int J Soc Res Methodol. 2018;21(5):619–34.

    Article  Google Scholar 

  23. 23.

    Martinez Tyson D, Vázquez-Otero C, Medina-Ramirez P, Arriola NB, McMillan SC, Gwede CK. Understanding the supportive care needs of Hispanic men cancer survivors. Ethn Health. 2017;22(1):1–16.

    PubMed  Article  Google Scholar 

  24. 24.

    Martinez Tyson D, Sommariva S, Walsh-Felz A, Sherry P, Sandberg J. Exploring the employment challenges and concerns of minority women cancer survivors. Ca Health Dis. 2019;3.

  25. 25.

    Tyson DM, Arriola NB, Medina-Ramirez P, Ðao LU, Smith CA, Livingston T. “You have to control it however you can”: type 2 diabetes management in a Hispanic farmworker community in rural Florida. Hum Organ. 2019;78(3):205–17.

    Article  Google Scholar 

  26. 26.

    Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.

    PubMed  Article  Google Scholar 

  27. 27.

    Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408.

    Google Scholar 

  28. 28.

    Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Sage publications; 2011.

  29. 29.

    Friese S. ATLAS. ti 8 Windows-Inter-Coder Agreement Analysis Copyright© 2020 by ATLAS. ti Scientific Software Development GmbH, Berlin. All rights reserved. Manual Version: 669.20200507. Updated for program version: 8.4.

  30. 30.

    Graczyk M, Borkowska A, Krajnik M. Why patients are afraid of opioid analgesics: a study on opioid perception in patients with chronic pain. Pol Arch Intern Med. 2018;128(2):89–97.

    PubMed  Google Scholar 

  31. 31.

    Bulls HW, Hoogland AI, Craig D, Paice J, Chang YD, Oberoi-Jassal R, et al. Cancer and opioids: patient experiences with stigma (COPES)—a pilot study. J Pain Symptom Manag. 2019;57(4):816–9.

    Article  Google Scholar 

  32. 32.

    Rigg KK, Lawental M. Perceived risk associated with MDMA (ecstasy/molly) use among African Americans: what prevention and treatment providers should know. Subst Use Misuse. 2018;53(7):1076–83.

    PubMed  Article  Google Scholar 

  33. 33.

    Brown M, Bussell J. Medication adherence: WHO cares?. In Mayo Clinic Proceedings 2011 (Vol. 86, no. 4, pp. 304-314). Elsevier.

  34. 34.

    Research CfDEa. Roles of different participants in REMS. 2020. https://www.fda.gov/drugs/risk-evaluation-and-mitigation-strategies-rems/roles-different-participants-rems.

    Google Scholar 

  35. 35.

    Kear C, McKeithen T, Robertson S. ER/LA opioid REMS and accredited education: survey results provide insight into clinical roles, educational needs, and learner preferences. Subst Abus. 2017;38(2):145–9.

    PubMed  Article  Google Scholar 

  36. 36.

    Smith TG, Troeschel AN, Castro KM, Arora NK, Stein K, Lipscomb J, et al. Perceptions of patients with breast and colon cancer of the management of cancer-related pain, fatigue, and emotional distress in community oncology. J Clin Oncol. 2019;37(19):1666–76.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Brown JH, Torres HP, Maddi RD, Williams JL, Dibaj SS, Liu D, et al. Cancer patients’ perceived difficulties filling opioid prescriptions after receiving outpatient supportive care. J Pain Symptom Manag. 2020;60(5):915–22.

  38. 38.

    Knopf-Amelung S, Gotham H, Kuofie A, Young P, Stinson RM, Lynn J, et al. Comparison of instructional methods for screening, brief intervention, and referral to treatment for substance use in nursing education. Nurse Educ. 2018;43(3):123–7.

    PubMed  Article  Google Scholar 

  39. 39.

    Compton P, Blacher S. Nursing education in the midst of the opioid crisis. Pain Manag Nurs. 2020;21(1):35–42.

    PubMed  Article  Google Scholar 

  40. 40.

    Chiu AS, Healy JM, DeWane MP, Longo WE, Yoo PS. Trainees as agents of change in the opioid epidemic: optimizing the opioid prescription practices of surgical residents. J Surg Educ. 2018;75(1):65–71.

    PubMed  Article  Google Scholar 

  41. 41.

    Jacobsen R, Møldrup C, Christrup L, Sjøgren P. Patient-related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci. 2009;23(1):190–208.

    PubMed  Article  Google Scholar 

  42. 42.

    Matthias MS, Johnson NL, Shields CG, Bair MJ, MacKie P, Huffman M, et al. “I’m not gonna pull the rug out from under you”: patient-provider communication about opioid tapering. J Pain. 2017;18(11):1365–73.

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Black DW, Grant JE. DSM-5® guidebook: The essential companion to the diagnostic and statistical manual of mental disorders. American Psychiatric Pub. 2014.

  44. 44.

    Heit HA, Gourlay DL. DSM-V and the definitions: time to get it right. Pain Med. 2009;10(5):784–6.

    PubMed  Article  Google Scholar 

  45. 45.

    Volkow ND, McLellan AT. Opioid abuse in chronic pain—misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–63.

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Bell K, Salmon A. Pain, physical dependence and pseudoaddiction: redefining addiction for ‘nice’people? Int J Drug Policy. 2009;20(2):170–8.

    PubMed  Article  Google Scholar 

  47. 47.

    Kwon JH, Tanco K, Hui D, Reddy A, Bruera E. Chemical coping versus pseudoaddiction in patients with cancer pain. Palliat Supportive Care. 2014;12(5):413–7.

    Article  Google Scholar 

  48. 48.

    Penney LS, Ritenbaugh C, DeBar LL, Elder C, Deyo RA. Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study. BMC Fam Pract. 2016;17(1):1–15.

    Article  Google Scholar 

  49. 49.

    Leppin AL, Fernandez C, Tilburt JC. Missed opportunities: a mixed-methods analysis of CAM discussions and practices in the management of pain in oncology. J Pain Symptom Manag. 2016;52(5):719–26.

    Article  Google Scholar 

  50. 50.

    Koyyalagunta D, Bruera E, Aigner C, Nusrat H, Driver L, Novy D. Risk stratification of opioid misuse among patients with cancer pain using the SOAPP-SF. Pain Med. 2013;14(5):667–75.

    PubMed  Article  Google Scholar 

  51. 51.

    Manchikanti L, Manchikanti KN, Kaye AD, Kaye AM, Hirsch JA. Challenges and concerns of persistent opioid use in cancer patients. Expert Rev Anticancer Ther. 2018;18(7):705–18.

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Sutradhar R, Lokku A, Barbera L. Cancer survivorship and opioid prescribing rates: a population-based matched cohort study among individuals with and without a history of cancer. Cancer. 2017;123(21):4286–93.

    PubMed  Article  Google Scholar 

  53. 53.

    Hurstak EE, Kushel M, Chang J, Ceasar R, Zamora K, Miaskowski C, et al. The risks of opioid treatment: perspectives of primary care practitioners and patients from safety-net clinics. Subst Abus. 2017;38(2):213–21.

    PubMed  PubMed Central  Article  Google Scholar 

  54. 54.

    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama. 2016;315(15):1624–45.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  55. 55.

    Serdarevic M, Striley CW, Cottler LB. Gender differences in prescription opioid use. Curr Opin Psychiatry. 2017;30(4):238–46.

    PubMed  PubMed Central  Article  Google Scholar 

  56. 56.

    Barclay JS, Owens JE, Blackhall LJ. Screening for substance abuse risk in cancer patients using the opioid risk tool and urine drug screen. Supp Care Cancer. 2014;22(7):1883–8.

    Article  Google Scholar 

  57. 57.

    Swarm RA, Paice JA, Anghelescu DL, Are M, Bruce JY, Buga S, et al. Adult cancer pain, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2019;17(8):977–1007.

    CAS  Article  Google Scholar 

  58. 58.

    Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(27):3325–45.

    Article  Google Scholar 

  59. 59.

    Torres MB, Eskander MF, Held J, Chang Y, Harris J. The general surgeon’s role in enhancing patient education about prescription opioids. Bull Am Coll Surg. 2017;102(8):15–20.

    Google Scholar 

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Acknowledgments

Special thanks to the members of our community advisory board, LUNA Inc., Faces of Courage, Dr. Cathy Meade, Dr. Clement Gwede, and the Tampa Bay Community Cancer Network.

Funding

This work was supported by the Geographic Management of Cancer Health Disparities Program (GMaP) Region 2 funded by the National Institutes of Health grant 3P30 CA076292–19.

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Correspondence to Dinorah Martinez Tyson.

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The study was approved by the (Blinded for Review) Scientific Review Committee and the (Blinded for Review) Institutional Review Board. Informed consent was obtained for all study participants.

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Tyson, D.M., Chavez, M.N., Lake, P. et al. Perceptions of prescription opioid medication within the context of cancer survivorship and the opioid epidemic. J Cancer Surviv (2021). https://doi.org/10.1007/s11764-020-00952-1

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Keywords

  • Cancer survivorship; opioids
  • Pain management
  • Opioid epidemic