Highlights
- •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.
Abstract
Patients with advanced cancer are commonly prescribed opioids, yet patient attitudes
about opioid risks (eg, opioid use disorder, or OUD) are understudied. Our objective
was to use in-depth qualitative interviews to understand perceptions of opioid prescribing
and OUD in patients with advanced, solid-tumor cancers and their support people. We
conducted a qualitative study using a rigorous inductive, qualitative descriptive
approach to examine attitudes about OUD in patients with advanced cancer (n = 20)
and support providers (n = 11). Patients with cancer hold 2 seemingly distinct views:
prescription opioids are addictive, yet OUD cannot happen to me or my loved one. Participants
described general concerns about the addictive nature of prescription opioids (“My
biggest concern… would just be the risk of getting addicted to the medication or even
like, overdosing it”), while separating cancer pain management from OUD when considering
prescription opioid risks and benefits (“They need to make sure they get the right
ones, when they're taking it away from you.”). Finally, participants identified personal
characteristics and behaviors that they felt were protective against developing OUD
(commonly control, willpower, and responsibility). This rigorous qualitative study
demonstrates that patients with advanced cancer and their support people simultaneously
hold concerns about the addictive nature of prescription opioids, while distancing
from perceptions of OUD risks when using opioids for cancer pain management. Given
high rates of opioid exposure during advanced cancer treatment, it is important to
explore opportunities to promote a balanced understanding of prescription opioid use
and OUD risks in this population.
Perspective
Though prescription opioids carry risk of OUD, there is little data to help guide
patients with advanced cancer. Findings suggest that there is a need to develop new,
innovative strategies to promote effective pain management and minimize opioid risks
in this complex population.
Key words
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Article info
Publication history
Published online: January 26, 2023
Accepted:
January 19,
2023
Received in revised form:
December 28,
2022
Received:
September 12,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
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.
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