Abstract
Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new “tool” in this regard is the emergence of abuse-deterrent opioid formulations.
Highlights
The Cali Cancer Registry (CCR) is the best-known population-based source for descriptive epidemiology of cancer in Colombia and in South America at large; dating back to 1962, it is the oldest cancer registry in Latin America (1989)
Most Colombians who present with cancer are in an advanced disease state at the time of diagnosis
Cancer patients may be at special risk for opioid misuse, abuse, and even addiction
Summary
The Cali Cancer Registry (CCR) is the best-known population-based source for descriptive epidemiology of cancer in Colombia and in South America at large; dating back to 1962, it is the oldest cancer registry in Latin America (1989). Gourlay described universal precautions for prescribing opioid analgesics, including assessment of risk, informed consent, treatment agreements (spelling out in writing the expectations of the physician and clinic), and regular re-assessments of both pain and aberrant-drug taking behaviors (Gourlay et al, 2005). Ongoing or a recent history of substance abuse and certain mental health disorders are known risk factors for opioid misuse and abuse, but the specific prevalence of these conditions in the cancer population has not been thoroughly elucidated. New definitions and methodologies must be developed to better evaluate risk factors for opioid abuse in diverse populations—for example, newly diagnosed cancer patients vs patients currently in remission but dealing with chronic pain or treatment-related pain syndromes.
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