Long-Term Opioid Prescribing among Patients Living with Metastatic Cancer as a Chronic Disease
Patients living with metastatic cancer often experience pain which requires involvement of palliative care and symptom management teams. Opioids are a commonly used tool for the treatment of this cancer-related pain. While opioids serve an important purpose in symptom management and end-of-life care, harms related to their use are increasingly recognized as having a significant impact on patients with cancer. This changing perception has resulted from a growing body of literature investigating opioid-related harms, such as long-term prescribing, opioid-related healthcare utilization, and nonmedical use within cancer populations. However, many of these studies exclude patients with metastatic disease, and very few specifically investigate this population. The work reported in this thesis aims to address this knowledge gap by reviewing perceptions of opioid use among patients with metastatic disease, investigating the incidence of opioid-related hospitalizations and emergency department visits among recipients of long-term opioid prescribing, and determining the contribution of nonmedical opioid use to these encounters. Based on a review of previously published literature, stigmatization of opioid use was identified as a significant barrier to effective cancer pain management. Patients reported fears of addiction, tolerance, and side-effects which led to opioid-restricting behaviours. Despite these reported concerns, a large proportion of patients in Alberta received long-term opioid prescribing, with 23% of opioid-naïve patients with chronic metastatic disease being affected. Among these patients, the incidence of opioid-related healthcare encounters was higher than that reported in other cancer populations and was significantly associated with higher dosage and concurrent prescribing of psychoactive medications. Increased implementation of harm-reduction measures may be useful to mitigate this risk. From reviewing medical records of patients who experienced opioid-related healthcare encounters, nonmedical opioid use was identified as a possible contributing factor for 35% of patients. However, a majority of encounters were not primarily attributable to nonmedical opioid use and many patients experienced poorly controlled pain and displayed possible manifestations of opioid stigma. While risk assessment for nonmedical opioid use is important for patients receiving long-term opioid prescribing, it should be conducted in a non-stigmatizing manner which encourages patients to prioritize effective management of their pain.
Opioid, Palliative Care, Cancer Pain, Metastatic Cancer
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