Abstract
Background: Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis. Methods: The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient’s prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. Results: Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. Conclusion: Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. Plain Language Summary: Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3978-3986 |
| Number of pages | 9 |
| Journal | cancer |
| Volume | 129 |
| Issue number | 24 |
| DOIs | |
| State | Published - Dec 15 2023 |
Funding
Dmitry Khodyakov reports being the creator of ExpertLens, which was used to collect data in the study, grant funding from the Cambia Health Foundation, and he is the creator of ExpertLens. Robert M. Arnold reports independent contractor fees from VitalTalk and intellectual property royalties. Hailey W. Bulls reports grant and/or contract funding from the National Cancer Institute. Benjamin Han reports grant and/or contract funding from the National Institute on Drug Abuse. Jane M. Liebschutz reports consulting fees from Biomotivate, Inc and grant and/or contract funding from the National Institutes of Health. Jessica S. Merlin reports consulting fees from the Center to Advance Palliative Care and Oakstone Publishing and grant and/or contract funding from Cambia Health Foundation. Jeni Morrison reports travel funding from the University of Pittsburgh. Christine S. Ritchie reports grant and/or contract funding from the National Institutes of Health. The other authors declare no conflicts of interest.
Keywords
- cancer
- cancer pain
- opioids
- stimulants
- substance use
ASJC Scopus subject areas
- Oncology
- Cancer Research
