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Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients

Published:November 14, 2017DOI:https://doi.org/10.1016/j.jpain.2017.11.001

      Highlights

      • A registry with patient characteristics, treatments, and outcomes of cancer patients.
      • Average pain intensity was mild for 24.6%, moderate for 41.5%, and severe for 33.9%.
      • Median daily opioid dose in morphine equivalents was 109 (range = .4 to 3,960).
      • Men are twice as likely as women to have an opioid ordered at a higher dosage.
      • Opioid use and dosage are essential to understand patient reported outcomes.

      Abstract

      The Memorial Sloan Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EuroQOL 5 dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category. Eighty-six percent of patients received an opioid at 1 or more clinic encounters. Regression analysis revealed that male sex or being younger (65 years of age or younger) was associated with a greater likelihood of an opioid ordered. Male sex nearly doubled the likelihood of a higher dose being ordered than female sex. Bivariate analysis found that patients receiving opioids reported significantly more pain relief than no-opioid patients. However, patients receiving opioids had higher pain interference scores, lower index of health state, and more physical distress than no-opioid patients Our results identify the need to consider opioid use and dosage when attempting to understand patient-reported outcomes (PROs) and factors affecting pain management.

      Perspective

      This report describes the results of the analyses of PROs and patient-related electronic health record data collected under standard of care from cancer patients at outpatient pain management clinics of Anesthesiology and Palliative Care at the Memorial Sloan Kettering Cancer Center. Consideration of sex and age as predictors of opioid use is critical in attempting to understand PROs and their relationship to pain management.

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