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.
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30.
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.
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.
Brown MR, Ramirez JD, Farquhar-Smith P. Pain in cancer survivors. Br J Pain. 2014;8(4):139–53.
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.
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.
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.
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.
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.
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.
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.
Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin. 2011;61(3):157–82.
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.
Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps. BJA: Br J Anaesth. 2017;119(4):723–36.
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.
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.
Greene MS, Chambers RA. Pseudoaddiction: fact or fiction? An investigation of the medical literature. Current addiction reports. 2015;2(4):310–7.
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.
Bernard RH. Research methods in anthropology: Qualitative and quantitative approaches. Rowman & Littlefield. 2017.
Patton M. Purposeful sampling and case selections: overview of strategies and options. Qual Res Evaluation Methods. 2015:264–315.
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.
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.
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.
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.
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.
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.
Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408.
Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Sage publications; 2011.
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.
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.
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.
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.
Brown M, Bussell J. Medication adherence: WHO cares?. In Mayo Clinic Proceedings 2011 (Vol. 86, no. 4, pp. 304-314). Elsevier.
Research CfDEa. Roles of different participants in REMS. 2020. https://www.fda.gov/drugs/risk-evaluation-and-mitigation-strategies-rems/roles-different-participants-rems.
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.
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.
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.
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.
Compton P, Blacher S. Nursing education in the midst of the opioid crisis. Pain Manag Nurs. 2020;21(1):35–42.
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.
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.
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.
Black DW, Grant JE. DSM-5® guidebook: The essential companion to the diagnostic and statistical manual of mental disorders. American Psychiatric Pub. 2014.
Heit HA, Gourlay DL. DSM-V and the definitions: time to get it right. Pain Med. 2009;10(5):784–6.
Volkow ND, McLellan AT. Opioid abuse in chronic pain—misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–63.
Bell K, Salmon A. Pain, physical dependence and pseudoaddiction: redefining addiction for ‘nice’people? Int J Drug Policy. 2009;20(2):170–8.
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.
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.
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.
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.
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.
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.
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.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama. 2016;315(15):1624–45.
Serdarevic M, Striley CW, Cottler LB. Gender differences in prescription opioid use. Curr Opin Psychiatry. 2017;30(4):238–46.
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.
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.
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.
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.
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.
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.
Conflict of interest
The authors declare that they have no conflict of interest.
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.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Cancer survivorship; opioids
- Pain management
- Opioid epidemic