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Outcomes
1. Explain the benefits of universal screening for substance use disorder
2. Formulate a plan to manage cancer patients on opioids with, or at high risk of, substance use disorder
Importance
There are few guidelines on how to manage substance use disorder (SUD) in cancer patients taking opioids. The urine drug screen (UDS) and the opioid risk tool (ORT) have been used, usually randomly or when clinicians suspect SUD. There is a lack of data on the longitudinal outcome of cancer patients with SUD and opioids managed by a palliative clinic.
Objective(s)
This study explored the longitudinal management and outcome of cancer patients on opioids in a palliative care clinic that universally screened for SUD with UDS and ORT
Method(s)
A retrospective chart review was performed on patient visits to a palliative care clinic in September 2019. We evaluated all UDS results, abnormal drug behaviors, changes to treatment plans after abnormal behaviors or UDS results, and their longitudinal outcomes.
Results
204 patients met inclusion criteria (cancer diagnosis, currently prescribed opioids, and had UDS results). 187 (91.6%) patients had no abnormal UDS results, 17 patients (8.3%) had at least one abnormal UDS result, and 6 of the 17 patients had persistently abnormal UDS results. Mean ORT score for patients with abnormal UDS results was 7.4 and 2.8 for patients without abnormal UDS results. Treatment plan changes included frequent clinic visits and UDS, small supplies of opioids, and weaning or rotating opioids. Patients with advanced or incurable cancers remained on higher-dose opioids, and those being treated with curative intent were transitioned to buprenorphine or weaned from opioids. No patients were noted to have overdosed or needed other emergency medical care for SUD.
Conclusion(s)
In the setting of universal screening, less than 3% of patients had persistently abnormal UDS results. These patients were safely managed with a standardized protocol.
Impact
Universal UDS and ORT can be used to screen for SUD in cancer patients in a palliative clinic. Standardized protocols including decreased amount of opioids, frequent visits, and opioid rotation may be useful tools for patients with serious SUD and cancer-related pain.
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Copyright
© 2022 Published by Elsevier Inc.
