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Amaram-Davila J, Vega MF, Kim MJ, Dalal S, Dev R, Tanco K, Admane S, De Moraes AR, Thomas LA, Shelal Z, Gogineni M, Bramati P, Urbauer D, Hui D, Arthur J, Haider A, Bruera E, Reddy A. Perceptions Towards Naloxone among Patients with Cancer Receiving Opioids. J Pain Symptom Manage 2024:S0885-3924(24)00991-6. [PMID: 39218123 DOI: 10.1016/j.jpainsymman.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/15/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
CONTEXT Naloxone nasal spray is recommended for patients with risk factors for opioid overdose. However, cancer patients' perceptions and beliefs regarding naloxone prescriptions and their self-perceived risks for overdose are understudied. OBJECTIVE To determine the proportion of cancer patients at risk for overdose who perceived naloxone as beneficial. METHODS Between July 2020 and April 2022, we surveyed 150 adult patients from the supportive care ambulatory clinic at a tertiary cancer center in the United States who received a co-prescription of naloxone nasal spray. We measured patients' knowledge of overdose risk-factors, attitudes, beliefs, and education received on naloxone. Risk-factors between beneficial vs. non-beneficial groups were analyzed. The survey was administered on paper or via a telephone interview. RESULTS Of the 150 patients, 55% were male, 70% were white, and 81% had advanced cancer. The majority of patients believed naloxone was beneficial (100/150, 67%). When compared to the non-beneficial group, more patients from the beneficial group agreed that the concurrent use of alcohol (100% vs. 90%;p=0.004) or sedating drugs (96% vs.85%;p=0.04) with opioids could result in overdoses and felt safe having naloxone at home (95% vs. 60%;p<0.0001). More patients from the non-beneficial group associated naloxone prescription with being suspected of misusing opioids (12/50 vs. 8/100;p=0.01), and fewer had confidence in their caregivers' ability to administer naloxone (69% vs. 95%;p<0.0001). CONCLUSION Most patients understood the benefits of naloxone and felt safe having one at home. More research is needed to identify knowledge gaps and develop educational strategies for those who find it non-beneficial.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
| | - Maria Franco Vega
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Min Ji Kim
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Shalini Dalal
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Rony Dev
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Sonal Admane
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Aline Rozman De Moraes
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Lisa A Thomas
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | | | - Meghana Gogineni
- The University of Texas Southwestern Medical School, Dallas, Texas
| | - Patricia Bramati
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas
| | - David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Joseph Arthur
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Ali Haider
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Akhila Reddy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
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Loverock A, Marshall T, Viste D, Safi F, Rioux W, Sedaghat N, Kennedy M, Ghosh SM. Electronic harm reduction interventions for drug overdose monitoring and prevention: A scoping review. Drug Alcohol Depend 2023; 250:110878. [PMID: 37441959 DOI: 10.1016/j.drugalcdep.2023.110878] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Novel strategies are required to address rising overdose deaths across the globe. We sought to identify the breadth and depth of the existing evidence around electronic harm reduction (e-harm reduction) interventions that aimed to reduce the harms associated with substance use. METHODS We conducted a scoping review according to the PRISMA-ScR and PRISMA for Searching guidelines. A health sciences librarian systematically searched seven health databases from inception until January 20, 2023. Citation chaining and reference lists of included studies were searched to identify additional articles. Two reviewers independently screened, extracted and charted the data. Additionally, we conducted a gray literature search and environmental scan to supplement the findings. RESULTS A total of 51 studies met the criteria for inclusion (30 peer-reviewed articles and 21 non-peer reviewed). Most peer-reviewed studies were conducted in Western countries (USA = 23, Canada = 3, Europe = 3, China = 1) and among adult samples (adult = 27, youth/adults =1, unspecified = 2). Study designs were predominantly quantitative (n = 24), with a minority using qualitative (n = 4) or mixed methods (n = 2). Most e-harm reduction interventions were harm reduction (n = 15), followed by education (n = 6), treatment (n = 2), and combined/other approaches (n = 7). Interventions utilized web-based/mobile applications (n = 15), telephone/telehealth (n = 10), and other technology (n = 5). CONCLUSIONS While e-harm reduction technology is promising, further research is required to establish the efficacy and effectiveness of these novel interventions.
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Affiliation(s)
- Alexandra Loverock
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta T6G 1C9, Canada.
| | - Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Dylan Viste
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Fahad Safi
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | - Will Rioux
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | - Navid Sedaghat
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
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Amaram-Davila J, Reddy A, Clark MD, Nancherla A, Arthur J, Bruera E. Reliability of urine drug testing among patients on buprenorphine transdermal patch. Palliat Support Care 2023:1-3. [PMID: 37525588 PMCID: PMC10830884 DOI: 10.1017/s147895152300086x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results. CASE DESCRIPTION A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU. DISCUSSION Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient-physician relationships. CONCLUSION In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew D. Clark
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Nancherla
- University of the incarnate word, Feik school of Pharmacy, San Antonio, Tx, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Amaram-Davila J, Reddy A, Arthur J, Narayanan S, Gogineni M, Mallipeddi T, De Moraes AR, Maddi R, Shelal Z, Urbauer D, Chen M, Bruera E. Efforts to Improve Naloxone Co-Prescription for Patients With Cancer Pain at Risk of Opioid Overdose. J Palliat Med 2023; 26:969-973. [PMID: 37074064 PMCID: PMC10316523 DOI: 10.1089/jpm.2022.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 04/20/2023] Open
Abstract
Importance: Naloxone can be lifesaving in an opioid-related overdose (OD). However, the co-prescription of take-home naloxone (THN) is not widely adopted in routine clinical practice. We implemented a pilot program focused on increasing clinicians' awareness of THN and observed if this impacts THN prescriptions for our patients with cancer pain receiving opioids. Intervention: In January 2020, we initiated an educational program by twice-weekly video presentations and installed pamphlets in all clinic workstations highlighting the risk factors for ODs. We retrospectively reviewed electronic health records (EHR) of randomly selected patient visits, 200 each from eight weeks before intervention (BI) and eight weeks after the intervention (AI). Data on patient characteristics, risk factors for ODs, and THN prescriptions were collected. Results: In all, 380 unique patients were eligible for analysis. The median age was 60, 53% female, and 70% Caucasian. Eighty-two percent (152) BI and 73% (142) AI carried risk factors for ODs (p = 0.13). THN was prescribed to 21% (32/152) BI and 26% (37/142) AI (p = 0.53). Morphine-equivalent daily dose (MEDD) ≥100 mg (30%) and pulmonary disease (25%) were the most prevalent risk factors. The patient's likelihood of receiving a THN prescription increased by 0.9% for every 1-milligram increase in MEDD (p < 0.001, 95% confidence interval: 1.006-1.011). Conclusion: The educational intervention did not significantly increase the frequency of THN prescriptions. More direct interventions, including automatic EHR triggers, may need to be tested in future trials.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Meghana Gogineni
- The University of Texas, University of Southwestern School of Medicine, Dallas, Texas, USA
| | - Tarun Mallipeddi
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aline Rozman De Moraes
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Rama Maddi
- Department of Leukemia, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
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Tang M, Arthur J, Cooper A, Clark M, Bruera E. Nonmedical opioid use at the end of life: A tale of addiction and a last wish. Palliat Support Care 2023; 21:561-563. [PMID: 36545767 PMCID: PMC10175098 DOI: 10.1017/s1478951522001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nonmedical opioid use (NMOU) has been associated with opioid overdose deaths. This pattern of misuse can be seen in those using opioids for cancer-associated pain. We present a case that highlights the complexities associated with NMOU and a patient's care at the end of life. CASES DESCRIPTION A patient with a metastatic solid tumor malignancy along with co-occurring history of polysubstance abuse was admitted to an acute palliative and supportive care unit (APSCU). The patient demonstrated behaviors concerning for NMOU during her hospital stay but had increased symptom expression concerning for worsening dyspnea while in the APSCU. Unfortunately, she used home opioids, which was unknown to the team at the time along with requesting for higher doses of opioids that were being prescribed. This caused a worsening respiratory status and affected her care. Using an interdisciplinary approach, the providers managed her symptoms and discharged her safely to see her child. CONCLUSION This highlights the complexities of the alleviation of suffering in those with NMOU. It is important to continue to manage NMOU at the end of life due to its effects on quality of life. A multimodal approach is recommended to identify and care for these patients.
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Affiliation(s)
- Michael Tang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph Arthur
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexandra Cooper
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew Clark
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients. Cancers (Basel) 2023; 15:cancers15061809. [PMID: 36980695 PMCID: PMC10046317 DOI: 10.3390/cancers15061809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Cancer patients receiving palliative care may face significant challenges in attending outpatient appointments. Patients on controlled substances such as opioids require frequent visits and often rely on assistive devices and/or a caregiver to accompany them to these visits. In addition, pain, fatigue, and shortness of breath may magnify the challenges associated with in-person visits. The rapid adoption of telemedicine in response to the COVID-19 pandemic has proven to be highly beneficial for advanced cancer patients and caregivers. The hurried COVID-19-related implementation of telemedicine is now evolving into a permanent platform for providing palliative care. This review will focus on the best practices and recommendations to deliver high-quality, interdisciplinary tele-palliative care.
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7
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Amaram-Davila J, Kim MJ, Reddy A, Edwards T, Dai J, Urbauer D, Shelal Z, Ross Y, Hosain M, Bruera E, Arthur J. Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain. J Palliat Med 2023; 26:248-252. [PMID: 36476019 PMCID: PMC9894589 DOI: 10.1089/jpm.2022.0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Data on health care providers' (HCPs') perceptions about patients with cancer pain and nonmedical opioid use (NMOU) are lacking. We examined the perceptions and attitudes of HCPs and assessed the usefulness of an interdisciplinary opioid stewardship program (OSP) while caring for these patients. Methods: An anonymous cross-sectional survey was conducted among the supportive care HCPs between September and November 2021. Results: Of 85 HCPs, 64 responded (75%) to the survey. Participants perceived that NMOU is underdiagnosed (42/64; 67%), and caring for such patients is difficult (58/64, 91%) and time consuming (54/64, 87%). A majority (50/51, 98%) were aware of the OSP, and (48/51; 94%) found it helpful. Conclusion: HCPs reported that NMOU is underdiagnosed and is challenging to manage. They endorsed the utility of an OSP in managing patients with concurrent cancer pain and NMOU. Future research should identify ways to standardize care and integrate OSP in routine supportive oncology practice.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Min Ji Kim
- Department of Supportive and Palliative Care, Baylor University Medical Center, Dallas, Texas, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Tonya Edwards
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Yvette Ross
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Monawar Hosain
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
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8
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Arthur JA, Edwards T, Lu Z, Tang M, Amaram-Davila J, Reddy A, Hui D, Yennurajalingam S, Anderson AE, Jennings K, Reddy S, Bruera E. Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain. Cancer 2022; 128:3718-3726. [PMID: 35997289 PMCID: PMC10304363 DOI: 10.1002/cncr.34392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention. METHODS A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained. RESULTS NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13). CONCLUSIONS Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior.
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Affiliation(s)
- Joseph A. Arthur
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Tonya Edwards
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Zhanni Lu
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Michael Tang
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - David Hui
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Aimee E. Anderson
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Suresh Reddy
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
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Tang M, Reddy A. Telemedicine and Its Past, Present, and Future Roles in Providing Palliative Care to Advanced Cancer Patients. Cancers (Basel) 2022; 14:1884. [PMID: 35454791 PMCID: PMC9032063 DOI: 10.3390/cancers14081884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 12/20/2022] Open
Abstract
The landscape of healthcare delivery has considerably changed due to the emergence of coronavirus disease 2019 (COVID-19). This is nowhere more evident than in the care of advanced cancer patients receiving palliative care. This population is susceptible to the severe complications of COVID-19, and immediate measures had to be taken to ensure their safety. Thus, the adoption of telemedicine as a health care delivery model emerged. This model provides many benefits, such as improved access to care while maintaining social distancing; however, there exist challenges to this model, including health care disparities, reimbursement, and monitoring of opioids in high-risk populations. This narrative review provides an overview of the unique benefits and barriers of telemedicine in palliative care patients.
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Affiliation(s)
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA;
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10
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Bates N, Bello JK, Osazuwa-Peters N, Sullivan MD, Scherrer JF. Depression and Long-Term Prescription Opioid Use and Opioid Use Disorder: Implications for Pain Management in Cancer. Curr Treat Options Oncol 2022; 23:348-358. [PMID: 35254595 PMCID: PMC8899439 DOI: 10.1007/s11864-022-00954-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
OPINION STATEMENT Preventing depression in cancer patients on long-term opioid therapy should begin with depression screening before opioid initiation and repeated screening during treatment. In weighing the high morbidity of depression and opioid use disorder in patients with chronic cancer pain against a dearth of evidence-based therapies studied in this population, patients and clinicians are left to choose among imperfect but necessary treatment options. When possible, we advise engaging psychiatric and pain/palliative specialists through collaborative care models and recommending mindfulness and psychotherapy to all patients with significant depression alongside cancer pain. Medications for depression should be reserved for moderate to severe symptoms. We recommend escitalopram/citalopram or sertraline among selective serotonin reuptake inhibitors (SSRIs), or the serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine, venlafaxine, or desvenlafaxine if patients have a significant component of neuropathic pain or fibromyalgia. Tricyclic antidepressants (TCAs) (consider nortriptyline or desipramine, which have better anticholinergic profiles) should be considered for patients who do not respond to or tolerate SSRI/SNRIs. Existing evidence is inadequate to definitively recommend methylphenidate or novel agents, such as ketamine or psilocybin, as adjunctive treatments for cancer-related depression and pain. Physicians who treat patients with cancer pain should utilize universal precautions to limit the risk of non-medical opioid use (non-medical opioid use). Patients should be screened for non-medical opioid use behaviors at initial consultation and at regular intervals during treatment using a non-judgmental approach that reduces stigma. Co-management with an addiction specialist may be indicated for patients at high risk of non-medical opioid use and opioid use disorder. Buprenorphine and methadone are indicated for the treatment of opioid use disorder, and while they have not been systematically studied for treatment of opioid use disorder in patients with cancer pain, they do provide analgesia for cancer pain. While an interdisciplinary team approach to manage psychological stress may be beneficial, this may not be possible for patients treated outside of comprehensive cancer centers.
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Affiliation(s)
- Nicole Bates
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA. .,Department of Psychosocial Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave E, MS K2-231, PO Box 19023, Seattle, WA, 98109-1023, USA.
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, St. Louis, MO, 63110, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, 27710-4000, USA.,Duke Cancer Institute, Durham, NC, 27710, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, St. Louis, MO, 63110, USA.,The Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University, Saint Louis University School of Medicine, 3545 Lafayette Ave., St. Louis, MO, 63104, USA
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Pill Counting as an Intervention to Enhance Compliance and Reduce Adverse Outcomes with Analgesics Prescribed for Chronic Pain Conditions: A Systematic Review. Curr Pain Headache Rep 2022; 26:883-887. [PMID: 36459370 PMCID: PMC9716148 DOI: 10.1007/s11916-022-01091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Appropriate use of opioid analgesics is a key concern within the field of pain medicine. Several methods exist to discourage abuse and facilitate effective treatment regimens. Pill counting is often cited as one such method and frequently employed in varying fashions within clinical practice. However, to date, there is no published review of the evidence to support this practice. This was a comprehensive review of the available literature that was conducted with analysis of the efficacy and practical application of pill counting during treatment of chronic pain conditions. RECENT FINDINGS There is paucity in data regarding pill count importance in pain management. Pill count is a very important tool to monitor compliance of opioids use which in turn can prevent several complications associated with opioid misuse. Pill counting may be used in conjunction with other abuse deterrents, although increased support for this practice requires standardized methods of pill counting and further analysis of its effectiveness.
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