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Pain Management
Supportive Care

Parenteral Opioid Shortage Threatens Appropriate Pain Care for Patients With Cancer

In response to the opioid-overdose epidemic, several measures have been put in place, such as the reclassification of hydrocodone as a Schedule II opioid and new requirements for physician review of prescription drug–monitoring program databases in most states. Moreover, the Surgeon General and...

issues in oncology
pain management

Charles von Gunten, MD, PhD, on Protecting Opioid Access for Patients in Need

Charles von Gunten, MD, PhD, of OhioHealth, discusses the critical need for opioids to manage cancer pain as well as the myth of addiction, which may impede best care.

supportive care
pain management

Mihir M. Kamdar, MD, on Managing Cancer-Related Pain With Artificial Intelligence

Mihir M. Kamdar, MD, of Massachusetts General Hospital, discusses study findings on a smartphone app called ePAL, which significantly reduces pain and pain-related hospital admissions by combining patient-reported outcome data and artificial intelligence via a telemedicine platform (Abstract 76).

palliative care
pain management

Leslie J. Blackhall, MD, on Unregulated Opioid Access: Consequences and Outcomes

Leslie J. Blackhall, MD, of the University of Virginia, discusses abuse of opioids, prescribing responsibly, and reducing cancer pain while also decreasing the risk of misusing these agents.

Supportive Care
Pain Management

The Opioid Crisis From the Oncology Perspective

As the nation battles an escalating opioid-overdose crisis, which claims more than 100 lives per day, a new study presented at the 2018 ASCO Quality Care Symposium was designed to answer a heretofore unanswered question: How common are opioid-related deaths in patients with cancer?1 Unintended...

lung cancer
issues in oncology
pain management

Opioid Use Following Video-Assisted Thoracoscopic Surgery or Open Resection in Early-Stage Lung Cancer

In a study reported in a research letter in JAMA Oncology, Tuminello et al found that video-assisted thorascopic surgery (VATS) was less likely than open resection to be associated with long-term opioid use in patients undergoing surgery for early-stage lung cancer. Study Details The study...

lung cancer
pain management

Study Shows Invasive Lung Cancer Surgery Can Lead to Long-Term Opioid Use

Patients treated with more invasive surgical techniques for early-stage non–small cell lung cancer (NSCLC) are more likely to become chronic opioid users than patients treated with minimally invasive surgery, highlighting the need for additional research into how pain management after surgery ...

issues in oncology
symptom management
pain management

Angela M. Stover, PhD, on Patient-Reported Symptoms: Results From the STAR and PRO-TECT Trials

Angela M. Stover, PhD, of the University of North Carolina at Chapel Hill, discusses study findings on ways to alert clinicians when patients signal symptoms such as pain or diarrhea that may be cause for concern (Abstract 158).

issues in oncology
pain management

Jay B. Shah, MD, on Reducing Opioid Use After Urologic Oncology Surgery

Jay B. Shah, MD, of Stanford University, discusses the role that surgeons can play as gatekeepers to the opioid epidemic, including the view that complex cancer operations can be performed with little to no opioid use (Abstract 269).

issues in oncology
pain management
legislation

Fumiko Ladd Chino, MD, on Opioid-Associated Deaths in Patients With Cancer

Fumiko Ladd Chino, MD, of Duke University, discusses results from a population study she conducted of the opioid epidemic over the past 10 years and why these medications for cancer pain should continue to be excluded from restrictive-prescribing laws (Abstract 230).

issues in oncology
pain management

2018 Quality Care: New Approach Successfully Reduces Opioid Use After Urologic Oncology Surgery

In a study conducted by Stanford Health Care, researchers achieved a 46% reduction in opioid use among 443 patients with cancer who underwent a range of urologic surgeries without increasing their pain or anxiety. They achieved this reduction through a two-pillared approach: (1) maximizing the use...

issues in oncology
pain management

2018 Quality Care: Opioid Deaths Are 10 Times Less Likely to Occur in Patients With Cancer Compared to the General Population

According to the U.S. Department of Health and Human Services, in 2016, over 42,000 Americans died from opioid overdose, making the epidemic a top public health concern. Although opioids are commonly used for cancer-associated pain, the risks for overdose in patients with cancer were unknown. A...

Legislation
Pain Management

New Laws Limiting Opioid Prescriptions Create Undue Barriers for Patients With Cancer and Cancer Survivors

Among other policy responses to the growing opioid epidemic, many states have enacted legislation that limits the duration or amount of opioid prescriptions issued by physicians. Although, it is clear we need strong measures to mitigate widespread overuse and misuse of opioids. These...

Pain Management

Expert Point of View: Ian Olver, AM, MD, PhD

Though many case studies and anecdotal reports have touted the effectiveness of cannabinoids for cancer pain, in randomized studies, the areas in which they are effective are “fairly borderline,” according to Ian Olver, AM, MD, PhD, Immediate Past President of the Multinational Association of...

issues in oncology
pain management

Statement by FDA Commissioner on Opioid Access for Patients With Chronic and End-of-Life Pain

U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, recently issued the following statement. The opioid epidemic continues to take an emotional, physical, and financial toll on Americans. The FDA is committed to taking every possible step to address the many facets of this...

Gynecologic Cancers
Pain Management

Study Evaluates Effect of Restrictive Opioid Protocol After Gynecologic Surgery

THE NUMBER of opioids prescribed after surgery for gynecologic cancer decreased significantly after implementation of an ultra-restrictive opioid prescription protocol, with no apparent negative effect on patient satisfaction or pain, according to research presented by Jaron Mark, MD, and...

Solid Tumors
Colorectal Cancer
Supportive Care
Pain Management
Palliative Care
Survivorship
Issues in Oncology

Support, Inform Patients With ASCO Resources

Stock your practice with ASCO resources for your patients. Visit ASCO’s patient information website, Cancer.Net, for a newly updated comprehensive guide to colorectal cancer at cancer.net/colorectal and a shorter, one-page colorectal cancer fact sheet. Copies can be purchased from the ASCO...

breast cancer
pain management

SABCS 2017: Acupuncture May Reduce Joint Pain Caused by Aromatase Inhibitor Treatment

Acupuncture significantly reduced joint pain for postmenopausal women with early-stage breast cancer receiving treatment with an aromatase inhibitor compared with both sham acupuncture and no treatment, according to data from the randomized, phase III SWOG S1200 trial presented by Hershman et al at ...

Issues in Oncology
Pain Management

EXPECT QUESTIONS ABOUT THE RISK OF OPIOID ADDICTION

INTENSE MEDIA COVERAGE of the opioid crisis has ranged from the dire statistics of addiction and death to some hopeful stories of treatment and recovery, but what may raise questions and concerns are the reports of people who start with a prescription opioid and then in a few weeks or months are...

Pain Management

Relieving Pain During an Opioid Epidemic

“WE’VE GOT A CHALLENGING TIME right now, trying to relieve pain during the time of an opioid epidemic,” Judith A. Paice, RN, PhD, acknowledged at the 2017 Lynn Sage Breast Cancer Symposium in Chicago.1 She cited a recent study reporting that up to 40% of cancer survivors are living with pain, and...

pain management

Jenske Geerling, NP, on Painful Bone Metastases: Study Results on Nurse-Led Pain Education

Jenske Geerling, NP, of the University Medical Center Groningen, discusses findings from a multicenter trial on patient education, pain reduction, and quality of life (Abstract 203).

pain management

Jeremy Hirst, MD, on My Patient Needs Opiates and Benzodiazepines: What Should I Do?

Jeremy Hirst, MD, of the University of California, San Diego, offers concrete advice on assessing the need for these medications, using them safely, and knowing when to deprescribe them.

palliative care
pain management

Jacob J. Strand, MD, on Dealing With Opioid Use Disorders

Jacob J. Strand, MD, of the Mayo Clinic, discusses tips and tools that clinicians can use to develop universal precautions for prescribing opioids in oncology and palliative care practice.

pain management

Ontario Province–Wide Symptom Screening and Opioid Prescribing Rates in Older Patients With Cancer

In a study reported in the Journal of Oncology Practice, Barbera et al found that a province-wide effort to improve symptom screening and management has increased the frequency of screening but has not improved opioid prescription rates in elderly cancer patients with severe pain. A previous study...

survivorship
pain management

Higher Opioid Use Among Cancer Survivors

A new study found that opioid prescription use is more common in cancer survivors than in individuals without a history of cancer. This was true even among survivors who were 10 or more years past their cancer diagnosis. Published by Sutradhar et al in Cancer, the findings come at a time of rising...

Pain Management
Supportive Care

Pediatric Cancer Pain May Be Misunderstood and Largely Undertreated

Cancer pain in children poses certain unique challenges. Over the past decade, insightful research into pediatric cancer pain has focused on pain management that incorporates nonopioid therapies into standard care. To shed light on this important issue, The ASCO Post spoke with Christine T....

pain management

FDA Requests Removal of Oxymorphone Hydrochloride for Risks Related to Abuse

On June 8,the U.S. Food and Drug Administration (FDA) requested that Endo Pharmaceuticals remove its opioid pain medication, reformulated oxymorphone hydrochloride (Opana ER), from the market. After careful consideration, the agency is seeking removal based on its concern that the benefits of the...

symptom management
pain management

Peter Hoskin, MD, on Spinal Compression: Results From the SCORAD III Trial

Peter Hoskin, MD, of Mount Vernon Cancer Centre, discusses study findings on single-dose radiotherapy compared with multifraction radiotherapy in patients with metastatic spinal canal compression. (Abstract LBA10004)

pain management
symptom management

ASCO 2017: Single-Dose Radiotherapy as Effective as Multiple Fractions in Relieving Symptoms of Spinal Cord Compression

Spinal cord compression is a common complication in people with metastatic cancer and is a major detriment to quality of life. Radiation treatment is widely used to relieve pain and other symptoms, but there is no standard recommended schedule, and approaches currently vary. Findings from a phase...

issues in oncology
pain management

New Canadian Guideline Provides Advice to Physicians to Avoid Overprescribing of Opioids

Opioid overdoses are claiming the lives of thousands of Canadians. The impact of the opioid crisis continues to be devastating to individuals, families, and communities. Inappropriate prescribing of opioids has led to long-term dependence on this class of drugs. To help address problematic...

Health-Care Policy
Pain Management

ASCO Addresses New Policies That Threaten Access to Opioids

Since the mid-2000s, medication and illicit drug abuse in the United Sates has steadily increased, creating what has now been termed an “opioid epidemic.” In response, Congress and the Bush and Obama Administrations have launched intervention and regulatory proposals to help turn the troubling...

Pain Management

Combating Untreated Cancer-Related Pain

The problem of pain management facing clinicians today is twofold: how to ensure safe and effective treatment for patients with cancer in chronic pain, while avoiding the overuse of opioid medications and the potential for substance use disorder and diversion. According to the American Cancer...

Pain Management

Clinical Trials Actively Recruiting Patients With Cancer-Related Pain

Phase I Study Title: Qigong Mind-Body Exercise for Persistent Post-Surgical Pain in Breast Cancer Survivors: A Pilot Study Study Type: Phase I/interventional/single-group assignment Study Sponsor and Collaborators: Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Spaulding...

survivorship
pain management
breast cancer

Sophia Kustas Smith, PhD, MSW, on Depression and Fatigue: Self-Managed in 'Reimagine'

Sophia Kustas Smith, PhD, MSW, of Duke University, discusses study findings on an online, symptom self-management curriculum, known as www.reimagine.me, employed for breast cancer survivors with chronic pain (Abstract 182).

Pain Management

FDA Approves Extended-Release Morphine Product Formulated With Abuse-Deterrent Properties

On January 9, the U.S. Food and Drug Administration (FDA) ap­proved morphine sulfate extended-­release tablets with abuse-deterrent properties (Arymo ER), a C-II drug for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative...

pain management

FDA Approves Morphine Sulfate Extended-Release Tablets Formulated With Abuse-Deterrent Properties

On January 9, the U.S. Food and Drug Administration (FDA) approved morphine sulfate extended-release tablets formulated with abuse-deterrent properties (Arymo ER) for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative...

Pain Management
Symptom Management
Supportive Care
Issues in Oncology

Expect Questions About Medical Marijuana

“Whether or not individual professionals support the clinical use of herbal cannabis, all clinicians will encounter patients who elect to use it and therefore need to be prepared to advise them on cannabis-related clinical issues despite limited evidence to guide care,” according to a recently...

Supportive Care
Pain Management
Issues in Oncology
Symptom Management

Medical Marijuana: The Topic You Can’t Escape

With reports about new marijuana dispensaries sprouting up as more states approve the legal use of medical marijuana, and patients and family members questioning how to get it, medical marijuana is a “topic you can’t escape,” noted Judith A. Paice, PhD, RN.1 Dr. Paice is Director of the Cancer...

Pain Management
Survivorship

A Helping Hand, Just in Time: The ASCO Guideline for Managing Chronic Pain in Adult Cancer Survivors

With impeccable timing, as well as considerable forethought and planning, Dr. Paice and colleagues have produced a superb evidence-based guideline on “Management of Chronic Pain in Survivors of Adult Cancers.”1 (See this issue of The ASCO Post.) This summary of well-informed and thoroughly...

Pain Management
Survivorship

ASCO Clinical Practice Guideline on Management of Chronic Pain in Survivors of Adult Cancers

As reported in the Journal of Clinical Oncology by Judith A. Paice, PhD, RN, of Northwestern University, and colleagues, ASCO has released a clinical practice guideline on management of chronic pain in survivors of adult cancers.1 The guideline was based on literature review by an expert panel,...

pain management
global cancer care
palliative care

James F. Cleary, MD, on Global Access to Opioids

James F. Cleary, MD, of the University of Wisconsin Carbone Cancer Center, talks about the many reasons that 80% of the world’s population lacks access to opioids, the mainstay of cancer pain management.

palliative care
pain management
supportive care

Eduardo Bruera, MD, on Managing Opioid Use in Patients With a History of Addiction

Eduardo Bruera, MD, of The University of Texas MD Anderson Cancer Center, discusses the need for outpatient palliative care programs to monitor and support these complex patients and their family members.

survivorship
pain management

ASCO Releases Clinical Practice Guideline on Management of Chronic Pain in Survivors of Adult Cancers

As reported in the Journal of Clinical Oncology by Judith A. Paice, PhD, RN, of Northwestern University, and colleagues, ASCO has released a clinical practice guideline on management of chronic pain in survivors of adult cancers. The guideline was based on literature review by an expert panel, with ...

pain management

Fentanyl Nasal Spray Now Available at a Dose of 300 μg for Treatment of Breakthrough Cancer Pain

Fentanyl (Lazanda) nasal spray, a schedule II narcotic, is now available at a 300-μg dose to treat breakthrough cancer pain, offering physicians another titration option for dosing flexibility. The new strength can help physicians more easily and accurately target the appropriate dose for...

pain management

Early Study Looks to Achieve Chloride Homeostasis Through Gene Transfer to Alleviate Cancer-Related Neuropathic Pain

A study providing new information about neuropathic pain afflicting some 90% of cancer patients who have had nerve damage caused by tumors, surgery, chemotherapy, or radiation indicates gene therapy as a possible treatment. The study in rats showed transfer of a gene known as KCC2 into the spinal...

pain management

Judith Paice, PhD, RN, on Managing Cancer Pain: Strategies for Prescribing Opioids

Judith Paice, PhD, RN, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses strategies for safe opioid prescribing: making a comprehensive assessment, stratifying risk, using universal precautions, and educating practitioners on safe storage and disposal.

pain management
palliative care
symptom management
integrative oncology

Lorenzo Cohen, MD, on Acupuncture and Other Nondrug Pain Management Techniques

Lorenzo Cohen, MD, of The University of Texas MD Anderson Cancer Center, discusses nonpharmacologic approaches to symptom control. Techniques such as acupuncture for managing pain and chemotherapy-induced nausea and vomiting, or yoga and meditation to help improve quality of life, can be safely integrated into oncology care.

pain management

Judith Paice, PhD, RN, on Neuropathic Pain

Judith Paice, PhD, RN, of Northwestern University, reviews the current principles on assessing and treating neuropathic pain in cancer.

lung cancer
pain management

Brian D. Kavanagh, MD, on Improving Value and Elevating the Patient Care Experience

Brian D. Kavanagh, MD, of the University of Colorado School of Medicine, summarizes three papers: outcomes for locally advanced non–small cell lung cancer, 3D CRT vs image-guided intensity-modulated radiotherapy for reducing bowel toxicity, and dexamethasone for controlling pain flares in patients with bone metastases (Abstracts 2, 8, LBA6663).

Pain Management

First Fentanyl Nasal Spray Approved for Cancer Breakthrough Pain

The FDA has approved fentanyl nasal spray (Lazanda) for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain. This marks the first FDA product approval for...

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