Issues in Oncology: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: Results of a Restrictive Opioid Prescription Protocol for Patients With Cancer Undergoing Surgery, By Jo Cavallo

Josh Epworth

摘要

Seeing an opportunity to safely reduce the number of opioid doses prescribed to patients with cancer, researchers proposed a new pain management guideline for all patients undergoing surgery at Roswell Park Comprehensive Cancer Center. The results from the first 6 months of that effort, reported by Ricciuti et al during the 2021 ASCO Annual Meeting (Abstract 103), show that this opioid-restricting protocol resulted in a 45% decrease in the amount of opioids prescribed, without and significant effect on patient recovery or satisfaction. “The rates of opioid prescription in the United States for routine surgeries are significantly higher than in many European and Asian countries,” noted first author of the study, Jason Ricciuti, MD, a gynecologic oncology fellow at Roswell Park. “This is particularly problematic, because persistent opioid use has been observed in 6% to 8% of people who were not taking opioids until they underwent surgery.” “Our goal,” he added, “was to demonstrate that prescribing 3 or fewer days of opioid supply is feasible in most postsurgical patients without compromising recovery or patient satisfaction, and that this approach will decrease chronic opioid use.” The Advanced Practitioner Perspective: Currently, there is significant awareness of the hazards of a laissez-faire approach to opioid use. This awareness followed a period of significant increase in the number of prescriptions of this type of medication beginning in the 1990s and increasing again a decade ago. Since there has been a public reckoning with the utilization of these habit-forming medications, efforts have been made to decrease the number of opioids prescribed by all variety of providers. Because advanced practitioners in oncology are involved with the management of cancer-related side effects, one of which is pain, this is a subject that is very relevant to our practice. The abstract outlined a useful approach to addressing acute/postsurgical pain. The results indicate that the number of opioids prescribed post surgery can be reduced with a concentrated approach utilizing team champions, pharmacists, medical records personnel, and prescribers. Like all good studies, it also generates some questions: ?This work appears to focus on surgery-related pain. Can this approach be applied to cancer-related pain? ?Can some part of this approach be applied to chronic pain? What are some of the barriers (both personal and institutional) that may hamper a change in approach? ?This abstract focused exclusively on solid tumors. What can be done with these ideas in the setting of liquid tumors? Appropriate pain management is one of the hallmarks in quality cancer care. With the increased involvement of advanced practitioners in the management of cancer-related side effects, including pain, comes increased scrutiny over our approach to this issue. It behooves us as providers to implement approaches that allow us to achieve the goal of balancing adequate pain control with patient safety. In addition, the team-based tactic to implementing change in facility culture and practice is applicable beyond acute pain management and may well be considered for cancer-related pain management and a host of other issues.

Issues in Oncology: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: Results of a Restrictive Opioid Prescription Protocol for Patients With Cancer Undergoing Surgery, By Jo Cavallo

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