Leading Organizations Clear the Air on Opioid Use in Cancer Care

There is much confusion around opioid use in cancer care, so leading oncology and health organizations — the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), American Society of Hematology (ASH), the Centers for Disease Control and Prevention (CDC), and former FDA commissioner, Scott Gottlieb MD – recently band together to publish an article on proper pain management for cancer survivors.

“We all have the same goal: to help patients have the best quality-of-life possible,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN, in a press release. “That means ensuring access to appropriate, safe pain management, while not contributing to inappropriate opioid use and addiction.

“In recent years, the rise of opioid addiction and overdose in the United States has rightly led to increased scrutiny of opioid prescribing practices. However, multiple reports indicate that well-meaning regulatory and coverage policies have created significant barriers for many patients with cancer and sickle cell disease where careful opioid use may be clinically indicated for pain management. This is especially challenging for cancer survivors. Clinical practice guidelines can serve as a tool for policymakers to account for special populations and mitigate harm in policymaking,” Carlson said.

The article highlights differences among organizations’ recommendations for opioid use — especially when it comes to chronic pain, people being treated for cancer, survivors, and those with sickle cell disease – but it also emphasizes the consistencies among existing guidelines, too. They include:

• Using nonpharmacologic/non-opioid therapy
• Assessing a patient’s benefits/risks before prescribing opioids
• Developing/implementing strategies to mitigate risk of opioid misuse
• Monitoring effectiveness and necessity of opioid use
• Offering patient education on goals of treatment and safe opioid use
• Using adjuvant analgesics, psychosocial support, and interventional therapies alongside opioid use
• Gradually reducing opioid doses to prevent withdrawal

Contributors to the article, which was published in JCCN and JCO Oncology Practice including Gottlieb, advised against a “one-size-fits-all” approach for opioid use and restrictions. He and representatives from the CDC stressed science-based prescribing that took each patient situation into account.

The CDC also issued a letter of clarification outlining guidelines for clinicians. The agency said that it does not want to deny clinically appropriate therapy, when it comes to palliative care, cancer treatment, and end-of-life care, but ensure that the misuse or inappropriate use of opioids is avoided.

“As an oncology nurse, I regularly see patients experiencing major challenges accessing appropriate pain management, including opioids” said Judith Paice, PhD, RN, Director of the Cancer Pain Program in the Division of Hematology-Oncology at the Feinberg School of Medicine and Member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chair of the ASCO Clinical Practice Guideline for Management of Chronic Pain in Survivors of Adult Cancers, and Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Adult Cancer Pain.

“The barriers they experience can include challenges with their insurer or limited supplies in the pharmacy. Additionally, prescriber confusion around recommendations, including misunderstandings about guidelines can contribute to these challenges. We hope this clarification will facilitate better use of guidelines for payers, policymakers, and prescribers.”

More: Cancer Pain Management: Expert Talks Barriers, Management Strategies