Easing Opioids Compassionately: De-escalating High Dose Opioids in Cancer Survivorship

{"title":"Easing Opioids Compassionately: De-escalating High Dose Opioids in Cancer Survivorship","authors":"Kimberly Frier DNP APRN-CNP ACHPN FPCN,&nbsp;Justin Kullgren PharmD FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.037","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. The learner should achieve a contrast and comparison of different opioid de-escalation strategies for patients that have completed cancer treatment.</div><div>2. The learner should achieve a review of communication strategies for a compassionate approach to negotiating and approaching de-escalation of opioids.</div></div><div><h3>Key Message</h3><div>Patients are living longer with cancer and there is an increasing number of cancer survivors. This requires palliative care clinicians to be keenly aware of long-term opioid side effects along with when and how to taper opioids. This session will review opioid tapering strategies.</div></div><div><h3>Abstract</h3><div>With the population of cancer survivorship increasing, more studies are evaluating long term effects and management of various symptoms, including cancer and related pain (Kline, et. al., 2018). Healthcare providers are assessing pain more comprehensively, accounting for chronic pain, cancer pain, cancer treatment pain and other co-morbidity pain. There is more recognition of the long-term side effects of opioids and limitations of their use. In 2016 the CDC and ASCO (Dowell, et. al., &amp; Pace, et. al.,) released guidelines for managing opioids in chronic and cancer pain. Although the guidelines allowed for higher doses with terminal cancer or end-of-life situations, a ripple effect of the chronic pain guidelines were felt by many cancer survivors. Many of these patients are managed by outpatient Palliative Care/Clinics. The value of an interdisciplinary team in managing symptoms of cancer survivorship pain allows for individual de-escalating plans that address the holistic needs of cancer survivors. The purpose is to review two cases of cancer survivors managed on high dose opioids and the evidence-based process of slowly de-escalating opioids through a comprehensive, interdisciplinary team approach. One case will review de-escalation of opioids prior to cancer recurrence. One case will review de-escalation of high dose opioids in the face of disfiguring cancer treatment with no evidence of ongoing cancer.</div></div><div><h3>Objectives</h3><div>1. Participants will compare and contrast different opioid de-escalation strategies for patients that have completed cancer treatment. 2. Participants will review communication strategies for a compassionate approach to negotiating and approaching de-escalation of opioids.</div></div><div><h3>References</h3><div>Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464 Kline, R. M., Aurora, N. K., Bradley, C. J., Brauer, E.R., Graves, D. L., …Ganz, P. A. (2018). Long term survivorship care after cancer treatment: Summary of a 2017 national cancer policy forum workshop. Journal of the National Cancer Institute. 110(12): djy 176. doi: 10.1093/jnci/djy176 Pace, J.A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., … Bruera, E. (2016). Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 68:5206. doi.org/10.1200/JCO.2016.68.5206</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e429-e430"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425000971","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}