An evaluation of adult cancer-related neuropathic pain treatment at a large academic medical center.

Abstract

168 Background: Cancer-related neuropathic pain (CNP) is a common comorbidity among patients due to treatment and/or tumors that can cause neuronal damage. At present, there is no proven method to prevent CNP and no published widely followed national guideline for CNP management with a defined treatment algorithm. Further evaluation of CNP treatment is needed to help guide the development of clinical algorithms for CNP management. Methods: Health Data Compass, a data mining warehouse, was used to identify adults treated at the University of Colorado Hospital (UCH) who had a new diagnosis of cancer between January 1, 2014 and May 31, 2019 in addition to neuropathy during the same time frame. Individual patient electronic medical records were then reviewed for information unable to be obtained through Health Data Compass. The primary objective of the study was to describe CNP treatment at our facility. Descriptive statistics were used to define study population demographics and the primary outcome. Results: A total of 316 patients met study inclusion. The majority of the patients were white (86.7%) and female (67.4%). The most commonly included cancer types were breast (39.4%) and gastrointestinal (35.6%). Patients with all cancer stages were represented in the study. The majority of patients (n = 283) had a diagnosis code of neuropathy on or after the date of their cancer diagnosis; 33 patients had neuropathy documented prior to their cancer diagnosis. The most common CNP management strategies included: opioids only (37.7%), opioids, gabapentin or pregabalin, and an antidepressant (20.3%), opioids and antidepressants (19.6%), or opioids and gabapentin or pregabalin (17.7%). Nearly half of medications used in CNP were not prescribed prior to the patient’s neuropathy diagnosis date (47.3%). Approximately one-third of the patients (33%) had no dose changes from their initial CNP treatment dose. Conclusions: We completed a large single center study to identify the most commonly used medications for CNP treatment. The study included a wide variety of cancer types and all stages. Opioids were the most commonly used medication to treat CNP at UCH. Next steps will be to evaluate the efficacy of opioids compared to other treatment combinations for the management of CNP.