- •Patients with advanced cancer hold seemingly distinct views about prescription opioid risks.
- •Participants differentiate cancer pain management when considering opioid benefits and risks.
- •Participants conceptualize opioid use disorder as a choice.
- •Patients with advanced cancer use protective behaviors (eg, control) to limit opioid risks.
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- Policy forum: Ethical imperatives to overcome stigma against people with substance use disorders.AMA J Ethics. 2020; 22: 702-708
American Cancer Society Cancer Action Network, Patient quality of life coalition: Key findings summary: Opioid access research project. 2018. Available at:https://www.fightcancer.org/sites/default/files/ACS%20CAN%20PQLC%20Opioid%20Research%20Project%20Key%20Findings%20Summary%20Memo%20FINAL.pdf. Accessed June 1, 2022.
American Society of Clinical Oncology (ASCO): ASCO policy statement on opioid therapy: Protecting access to treatment for cancer-related pain. Available at:https://www.asco.org/sites/new-www.asco.org/files/content-files/advocacy-and-policy/documents/2016-ASCO-Policy-Statement-Opioid-Therapy.pdf. Accessed June 1, 2022.
- Racial and ethnic disparities in pain: Causes and consequences of unequal care.J Pain. 2009; 10: 1187-1204https://doi.org/10.1016/j.jpain.2009.10.002
- Cancer pain self-management in the context of a national opioid epidemic: Experiences of patients with advanced cancer using opioids.Cancer. 2021; 127: 3239-3245https://doi.org/10.1002/cncr.33532
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
- Cancer patients’ perceived difficulties filling opioid prescriptions after receiving outpatient supportive care.J Pain Symptom Manage. 2020; 60: 915-922https://doi.org/10.1016/j.jpainsymman.2020.06.015
- Exemptions to state laws regulating opioid prescribing for patients with cancer-related pain: A summary.Cancer. 2021; 127: 3137-3144https://doi.org/10.1002/cncr.33639
- A framework for opioid stigma in cancer pain.Pain. 2022; 163: e182-e189https://doi.org/10.1097/j.pain.0000000000002343
- Manifestations of opioid stigma in patients with advanced cancer: Perspectives from patients and their support providers.JCO Oncol Pract. 2022; 18: e1594-e1602https://doi.org/10.1200/OP.22.00251
- Cancer and opioids: Patient experiences with stigma (COPES): A pilot study.J Pain Symptom Manag. 2019; 57: 816-819https://doi.org/10.1016/j.jpainsymman.2019.01.013
- Identifying and assessing the risk of opioid abuse in patients with cancer: An integrative review.Subst Abuse Rehabil. 2016; 7: 71-79https://doi.org/10.2147/SAR.S85409
- The burden of psychosocial morbidity related to cancer: Patient and family issues.Int Rev Psychiatry. 2017; 29: 389-402https://doi.org/10.1080/09540261.2017.1288090
- U.S. trends and racial/ethnic disparities in opioid access among patients with poor prognosis cancer at the end of life (EOL).Am Soc Clin Oncol. 2020; 38: 7005https://doi.org/10.1200/JCO.2020.38.15_suppl.7005
- Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines.Ann Oncol. 2018; 29: 166-191https://doi.org/10.1093/annonc/mdy152
- Pain in cancer and chronic non-cancer conditions: Similarities and differences.Acta Anaesthesiol Scand. 2001; 45: 1086-1089https://doi.org/10.1034/j.1399-6576.2001.450906.x
- Recovery and self-management support following primary cancer treatment.Br J Cancer. 2011; 105: 21-28https://doi.org/10.1038/bjc.2011.419
- Pain in cancer survivors.J Clin Oncol. 2014; 32: 1739-1747https://doi.org/10.1200/JCO.2013.52.4629
- The unequal burden of pain: Confronting racial and ethnic disparities in pain.Pain Med. 2003; 4: 277-294https://doi.org/10.1046/j.1526 4637.2003.03034.x
- Differences in prescription opioid analgesic availability: Comparing minority and white pharmacies across michigan.J Pain. 2005; 6: 689-699https://doi.org/10.1016/j.jpain.2005.06.002
- Applied Thematic Analysis.SAGE Publications, Thousand Oaks2012
- Strategies to prevent opioid misuse, abuse, and diversion that may also reduce the associated costs.Am Health Drug Benefits. 2011; 4: 107-114
- Three approaches to qualitative content analysis.Qual Health Res. 2005; 15: 1277-1288https://doi.org/10.1177/1049732305276687
- Cognitive behavior therapy for patients with cancer.J Adv Pract Oncol. 2016; 6: 54-56
- Factors associated with black cancer patients’ ability to obtain their opioid prescriptions at the pharmacy.J Palliat Med. 2019; 22: 1143-1148https://doi.org/10.1089/jpm.2018.0536
- The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the united states.J Gen Intern Med. 2013; 28: 1604-1610https://doi.org/10.1089/jpm.2018.0536
- Characteristics of qualitative descriptive studies: A systematic review.Res Nurs Health. 2017; 40: 23-42https://doi.org/10.1002/nur.21768
- Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis.Pain. 2021; 162: 1840-1847https://doi.org/10.1097/j.pain.0000000000002173
- How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies.BMJ Support Palliat Care. 2016; 6: 263-275https://doi.org/10.1136/bmjspcare-2015-000958
- Mediating effect of family caregivers’ hesitancy to use analgesics on homecare cancer patients’ analgesic adherence.J Pain Symptom Manage. 2018; 56: 9-17https://doi.org/10.1016/j.jpainsymman.2015.06.014
- Unequal quality of cancer pain management: Disparity in perceived control and proposed solutions.Oncol Nurs Forum. 2007; 34: 1121-1128https://doi.org/10.1188/07.ONF.1121-1128
- A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home.BMC Palliat Care. 2014; 13: 39https://doi.org/10.1186/1472-684X-13-39
- Family caregivers and cancer pain management: A review.J Fam Nurs. 2011; 17: 29-60https://doi.org/10.1177/1074840710396091
- Interventions to enhance self-efficacy in cancer patients: A meta-analysis of randomized controlled trials.Psychooncology. 2019; 28: 1781-1790https://doi.org/10.1002/pon.5148
- A case for palliative care and addiction specialists collaboration and joint research.JAMA Netw Open. 2021; 4e2143436https://doi.org/10.1001/jamanetworkopen.2021.43436
- Phillips JK Ford MA Bonnie RJ Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse: Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press, Washington DC2017
National Comprehensive Cancer Network: NCCN Guidelines Version 2.2022-Adult Cancer Pain. Available at: https://www.nccn.org/. Accessed June 1, 2022.
- A delicate balance: Risks vs benefits of opioids in cancer pain.Pain. 2020; 161: 459-460https://doi.org/10.1097/j.pain.0000000000001773
- Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline.J Clin Oncol. 2016; 34: 3325-3345https://doi.org/10.1200/JCO.2016.68.5206
- Terminology of chronic pain: The need to “level the playing field.J Pain Res. 2016; 9: 23-24https://doi.org/10.2147/JPR.S99629
- Opioid therapy in cancer patients and survivors at risk of addiction, misuse or complex dependency.Front Pain Res. 2021; 2691720https://doi.org/10.3389/fpain.2021.691720
- The process of pain management in cancer patients at home: Causing the least harm: A grounded theory study.Indian J Palliat Care. 2020; 26: 457-467https://doi.org/10.4103/IJPC.IJPC_8_20
- Whatever happened toqualitative description?.Res Nurs Health. 2000; 23: 334-340https://doi.org/10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g
- This is a different patient population’: Oncologists’ views on challenges to safe and effective opioid prescribing for patients with cancer-related pain and recommendations for improvement.JCO Oncol Pract. 2021; 17: e1030-e1037https://doi.org/10.1200/OP.20.01041
- A systematic review of the patient- and carer-related factors affecting the experience of pain for advanced cancer patients cared for at home.J Pain Symptom Manage. 2018; 55: 496-507https://doi.org/10.1016/j.jpainsymman.2017.08.012
- Racial and ethnic disparities in cancer pain management.J Natl Black Nurses Assoc. 2009; 20: 11-18
- Psychological and behavioral approaches to cancer pain management.J Clin Oncol. 2014; 32: 1703-1711https://doi.org/10.1200/JCO.2013.54.4825
- A conceptual framework of self-advocacy in women with cancer.ANS Adv Nurs Sci. 2021; 44: E1-E13https://doi.org/10.1097/ANS.0000000000000342
- Stigma as a fundamental hindrance to the United States opioid overdose crisis response.PLoS Med. 2019; 16e1002969https://doi.org/10.1371/journal.pmed.1002969
- Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review.Drug Alcohol Depend. 2013; 131: 23-35https://doi.org/10.1016/j.drugalcdep.2013.02.018
- Opioids for cancer pain: An overview of Cochrane reviews.Cochrane Database Syst Rev. 2017; 7CD012592https://doi.org/10.1002/14651858.CD012592.pub2
- A systematic review of substance use and substance use disorders in patients with cancer.Gen Hosp Psychiatry. 2019; 60: 128-136https://doi.org/10.1016/j.genhosppsych.2019.04.016
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Y.S. and J.S.M. contributed equally to this work.
This work was supported by a grant from the Hillman Development Fund and the Palliative Research Center (PaRC) at the University of Pittsburgh. The project used resources provided through the Clinical Protocol and Data Management and Protocol Review and Monitoring System, which are supported in part by award P30CA047904. Dr. Bulls’ time was financially supported by an institutional K award at the University of Pittsburgh (NIH KL2 TR001856 [PI: Rubio]). Dr. Schenker was supported by K24AG070285. Dr. Hamm reports an immediate family member with employment at Arcadia Health Solutions. Dr. Wozniak holds the following consulting roles: BeyondSpring Pharmaceuticals, Epic, HUYA Bioscience International, Odonate Therapeutics, Janssen Oncology, GlaxoSmithKline, Regeneron, Novocure, OncLive/MJH Life Sciences, Premier, Inc, oncoboard, BeiGene, Incyte, Daiichi Sankyo/Lilly, kneis, Genentech. Dr. Merlin reports research funding from the Cambia Health Foundation outside of the scope of this work. Dr. Schenker reports honoraria from UpToDate outside of the scope of this work. No other potential COI.