In an interview study reported in JCO Oncology Practice, Yael Schenker, MD, MAS, and colleagues identified challenges and measures for improvement cited by oncologists in the safe and effective prescribing of opioids for their patients with cancer-related pain.
Yael Schenker, MD, MAS
Study Details
The investigators conducted interviews of 26 oncologists from urban and rural practices in Western Pennsylvania, with the interview guide querying oncologists regarding their views and experiences in treating cancer-related pain in the context of the opioid epidemic. Analysis of interview transcripts was performed by a multidisciplinary team to identify and refine themes related to challenges in opioid prescribing and recommendations for improvement.
Key Findings
Oncologists described three main challenges in prescribing opioids for cancer-related pain:
- Patients who receive opioids feel stigmatized by clinicians, pharmacists, and society.
- Patients fear becoming addicted, affecting their willingness to accept prescription opioids.
- Guidelines for safe and effective opioid prescribing are often misinterpreted, leading to access issues.
Recommendations for improving safe and effective prescribing were broken down into four main categories:
Education for Patients and Families
- Patient education regarding pain management and expectations of pain treatment
- Brochures, flyers, or booklets about opioid treatments and pain management
- Public health campaigns and commercials that clarify safe and appropriate uses of prescription opioid risks for cancer-related pain
Education and Treatment Resources for Oncologists
- Mandatory training for all opioid prescribers
- Conferences about palliative care and pain control
- Evidence-based guidelines about pain management in advanced cancer
- Easy-to-follow protocols and treatment pathways for pain management and supportive care
- Tools to measure risk for opioid misuse and diversion
Insurance Regulations
- Fewer restrictions from insurance companies regarding which opioids are covered, allowable opioid doses, and frequency of refills
- Information on insurance plan policies and coverage
Additional Support
- Social worker to help address social issues
- Support to deal with reporting requirements and prescription drug monitoring program checks and documentation
- Local, easily accessed pain management and/or palliative care
- Leveraging telemedicine for easier access to pain and palliative care experts
- On-site psychologists or therapists.
The investigators concluded, “Challenges to safe and effective opioid prescribing for cancer-related pain include … stigma and access barriers. Interventions that address opioid stigma and provide additional resources for clinicians navigating complex opioid prescribing guidelines may help to optimize cancer pain treatment.”
Dr. Schenker, of the Palliative Research Center and Section of Palliative Care and Medical Ethics, University of Pittsburgh, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by a grant from the Hillman Development Fund and the Palliative Research Center at the University of Pittsburgh and National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
