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      Cancer Patients’ Perceived Difficulties Filling Opioid Prescriptions After Receiving Outpatient Supportive Care

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          Abstract

          Context

          Limited access to opioids for cancer patients has been reported as a potential unintended consequence of recent regulations restricting opioid use and prescribing practices. To our knowledge, there are a limited number of peer-reviewed studies that evaluate cancer patients’ perceived difficulties when filling their opioid prescription. To understand these difficulties, we surveyed patients receiving opioids in our outpatient Supportive Care Center (SCC).

          Objectives

          The primary objective of this study was to evaluate cancer patients’ perceptions of overall difficulties when filling their opioid prescription. Secondary objectives included determining associations between patient characteristics and difficulty, and comparing difficulty between filling opioid and non-opioid prescriptions.

          Methods

          Cancer patients receiving opioids that had been seen two times or more at our SCC were asked to complete a survey. The information collected included patient demographics, clinical characteristics, and patients’ experiences filling their opioid prescription.

          Results

          The patients’ median age was 60 years; 54% were female and 69% were white. Forty-four patients (32%) reported that they have experienced difficulty filling their opioid prescription. More than 25% of those 44 patients perceived difficulty from interactions with the pharmacy/pharmacist. Forty-six patients (33%) reported more difficulty filling their opioid prescriptions than filling their non-opioid prescriptions.

          Conclusions

          This study provides evidence that patients with cancer visiting our SCC perceived difficulties obtaining their opioid prescriptions. The results suggest that negative interactions with the pharmacy/pharmacist contributes to their perceived difficulty. Additional research is needed to further characterize the contributors of the difficulties cancer patients face in filling their opioid prescriptions.

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          Most cited references21

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          Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer.

          Pain is a frequent symptom in patients with cancer, with substantial impact. Despite the availability of opioids and updated guidelines from reliable leading societies, undertreatment is still frequent.
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            Optimal pain management for patients with cancer in the modern era

            Pain is a common symptom amongst patients with cancer. Adequate pain assessment and management is critical to improve the quality of life and health outcomes in this population. In this review we provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder and considerations when managing pain in a survivorship population.
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              Pain and ethnicity in the United States: A systematic review.

              Evidence suggests that racial and ethnic disparities exist in access to effective pain treatment. To review evidence of these disparities and provide recommendations for care and further research. Systematic review. We conducted a MEDLINE search using the MeSH terms of ethnic groups, minority groups, pain, analgesia, and analgesics. We included studies describing current practice patterns, utilization of available treatments, treatment outcomes, and patient and provider knowledge, attitudes, and behaviors. Our search identified 35 journal articles describing the effect of patient race and ethnicity on pain assessment and management. Three studies on pain assessment revealed that minority patients are more likely to have their pain underestimated by providers and less likely to have pain scores documented in the medical record compared to whites. Eleven of 17 studies found that African Americans and Hispanics are less likely to receive opioid analgesics and more likely to have their pain untreated compared to white patients. Three studies revealed that minority patients are more likely to have negative pain management index (PMI) scores-undertreated pain-compared to whites. Patient-related, provider-related, and pharmacy-related barriers to effective pain management were identified. The majority of studies reveal racial and ethnic disparities in access to effective pain treatment akin to disparities found in other medical services. Quality improvement initiatives that improve treatment of pain for all patients according to established guidelines should decrease disparities by race or ethnicity. Educational interventions should aim to improve patient-provider communication regarding pain and its treatment and should provide support around substance abuse issues. Further research is needed to examine pain treatment outcomes and to determine whether health care system factors lead to these disparities.
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                Author and article information

                Contributors
                Journal
                J Pain Symptom Manage
                J Pain Symptom Manage
                Journal of Pain and Symptom Management
                Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine
                0885-3924
                1873-6513
                20 June 2020
                20 June 2020
                Affiliations
                [a ]Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
                [b ]Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
                Author notes
                []Corresponding Author: Eduardo Bruera, M.D., Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030. 713-792-6084. ebruera@ 123456mdanderson.org
                Article
                S0885-3924(20)30527-3
                10.1016/j.jpainsymman.2020.06.015
                7305512
                9ab9d7f2-1783-420f-be97-5e968dc2fe91
                © 2020 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 10 April 2020
                : 9 June 2020
                : 11 June 2020
                Categories
                Article

                analgesics,opioid,prescriptions,cancer pain,opioid epidemic,palliative care,pain management

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