ASCO, the American Society of Hematology (ASH), and the National Comprehensive Cancer Network® (NCCN®) recently acknowledged receipt of a key clarification1 from the Centers for Disease Control and Prevention (CDC) on prescribing opioids to manage pain from certain conditions. The clarification regarding the CDC’s Guideline for Prescribing Opioids for Chronic Pain2 came as a result of a collaborative effort by these organizations to clarify the CDC’s opioid prescribing guideline to ensure the safe and appropriate access for patients with cancer, cancer survivors, and individuals with sickle cell disease.
The CDC’s letter noted that the agency’s guideline was developed to provide recommendations for primary care clinicians who prescribe opioids for patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. It conveyed that the CDC’s guideline is not intended to deny clinically appropriate opioid therapy to any patients who suffer acute or chronic pain from conditions such as cancer and sickle cell disease, but rather to ensure that physicians and patients consider all safe and effective treatment options for pain management with the goal of reducing inappropriate use.
Clifford A. Hudis, MD, FACP, FASCO
“This clarification from CDC is critically important because while the agency’s guideline clearly states that it is not intended to apply to patients during active cancer and sickle cell disease treatment, many payers have been inappropriately using it to make opioid coverage determinations for those exact populations,” said ASCO Chief Executive Officer Clifford A. Hudis, MD, FACP, FASCO.
The CDC’s clarification further notes that clinical practice guidelines addressing pain control for survivors of cancer, such as the ASCO Clinical Practice Guideline on Management of Chronic Pain in Survivors of Adult Cancers3 and the NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain,4 are published and/or updated more recently than CDC’s guideline and provide important guidance on unique considerations when using opioids to control pain in cancer survivors without worsening the current opioid crisis.
Resolving Inconsistencies Among Guidelines
Robert W. Carlson, MD
“PRAGMATIC APPROACHES for pain management exist at the intersection of multiple health concerns,” said NCCN Chief Executive Officer Robert W. Carlson, MD. “CDC’s acknowledgment that clinical decision-making should be based on the relationship between physicians and their patients is important and in the best interest of people with cancer and sickle cell disease.”
In November 2018, ASCO, ASH, CDC, and NCCN representatives met to discuss concordance and variation among current guidelines for chronic pain management. They worked to develop a strategy to resolve inconsistencies, as well as improve communication of existing recommendations. The organizations also discussed issues related to the CDC guidelines and agreed jointly to seek clarification of the guidelines regarding their applicability to patients with cancer and sickle cell disease. Following the meeting, ASCO, ASH, and NCCN sent a letter to the CDC5 urging the clarification. ■
1. Dowell D: 2019 CDC opioid guideline clarification letter to ASCO, ASH, NCCN. asco.org. February 28, 2019. Available at www.asco.org/sites/new-www.asco.org/ files/content-files/advocacy-and-policy/documents/2019-CDC-Opioid-Guideline-Clarification-Letter-to-ASCO-ASH-NCCN.pdf. Accessed April 23, 2019.
2. Dowell D, Haegerich TM, Chou R: CDC Guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 65:1-49, 2016.
3. Paice JA, Portenoy R, Lacchetti C, et al: Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34:3325-3345, 2016.
4. Swarm R, Abernethy AP, Anghelescu DL, et al: Adult cancer pain. J Natl Compr Canc Netw 8:1046-1086, 2010.
5. Carlson RW, Hudis CA, Liggett M, et al: 2019 NCCN, ASCO, ASH Letter to CDC. February 13, 2019. Available at www.asco.org/sites/new-www.asco.org/ files/content-files/advocacy-and-policy/documents/2019-NCCN-ASCO-ASH-Letter-CDC.pdf. Accessed April 23, 2019.