Opioid Prescribing and Use Among Cancer Survivors: A Mapping Review of Observational and Intervention Studies

• Published in: Journal of pain and symptom management Vol. 63; no. 4; pp. e397 - e417
• Main Authors: Check, Devon K., Avecilla, Renee A.V., Mills, Coleman, Dinan, Michaela A., Kamal, Arif H., Murphy, Beverly, Rezk, Salma, Winn, Aaron, Oeffinger, Kevin C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2022
• Subjects: Analgesics, Opioid - therapeutic use; Cancer Survivors; chronic; high-risk; Humans; interventional; Neoplasms - drug therapy; observational; Opioid-Related Disorders - drug therapy; Practice Patterns, Physicians; Syntheses; observational; high-risk; interventional; chronic; Syntheses
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2021.10.015

Recent years show a sharp increase in research on opioid use among cancer survivors, but evidence syntheses are lacking, leaving knowledge gaps. Corresponding research needs are unclear.
To provide an evidence synthesis.
We searched PubMed and Embase, identifying articles related to cancer, and opioid prescribing/use published through September 2020. We screened resulting titles/abstracts. Relevant studies underwent full-text review. Inclusion criteria were quantitative examination of and primary focus on opioid prescribing or use, and explicit inclusion of cancer survivors. Exclusion criteria included end-of-life opioid use and opioid use as a secondary or downstream outcome (for intervention studies). We extracted information on the opioid-related outcome(s) examined (including definitions and terminology used), study design, and methods.
Research returned 16,591 articles; 296 were included. Only 22 of 296 studies evaluated an intervention. There were 105 studies evaluating outcomes indicative of potentially high-risk, nonrecommended, or avoidable opioid use, e.g., continuous use—described as chronic use, prolonged use, and persistent use (n = 17); use after completion of curative-intent treatment—described as chronic opioid use, long-term opioid use, persistent opioid use, prolonged opioid use, continued opioid use, late opioid use, post-treatment opioid use (n = 27); use of opioids concurrent with other potentially high-risk medications (n = 13), and opioid misuse (n = 14).
We found lack of consistency in the measurement of and terms used to describe similar opioid use outcomes, and a lack of interventional research targeting well-documented patterns of potentially nonrecommended, potentially avoidable, or potentially high-risk opioid prescribing or use.