Examination of the Screener and Opioid Assessment for Patients with Pain-Short Form (SOAPP-SF) in an oncology palliative medicine clinic.

Abstract

196 Background: The National Comprehensive Cancer Network states opioids can be used to treat cancer pain and prescribers should identify patients at risk for opioid misuse; research in this area is limited. In the non-cancer population, SOAPP-SF is a validated tool to predict aberrant drug behavior; a score of ≥ 4 (out of 20) is considered high risk. We performed a retrospective observational study to determine the utility of the SOAPP in identifying opioid misuse in the oncology population as measured by a non-compliant toxicology screen. Methods: Consecutive consults seen during a 6-month period completed the 5-question SOAPP-SF and Edmonton Symptom Assessment System (ESAS) form. Toxicology screens assessed non-compliance (i.e., absence of prescribed medications and/or presence of non-prescribed or illegal substances). Logistic regression models estimated the associations of composite and individual SOAPP-SF scores and ESAS symptom scores with non-compliant screens. Threshold analysis were conducted to identify an optimal SOAPP-SF cutoff. Results: Of 192 consults, 64 patients providing SOAPP-SF score and toxicology screen were evaluable. Mean age was 59 ± 9.8 years: 56% were female, 34% and 62% were African American and Caucasian respectively. Median SOAPP-SF score was 2 (range: [0, 12]). Non-compliant screens were observed in 31% of patients. The area under the curve (AUC) was 0.65. The validated SOAPP-SF cutoff score of ≥ 4 was associated with a sensitivity and specificity of 0.43 and 0.79, respectively (p = 0.082). Sensitivity (0.76) and specificity (0.72) were maximized at a cutoff score of ≥ 3 (p < 0.001). When evaluated individually, the SOAPP-SF question about smoking habit was associated with a non-compliant screen (p = 0.020). Increased ESAS pain scores were associated with SOAPP-SF score ≥ 3 (p = 0.013). Conclusions: SOAPP-SF can identify oncology patients at risk for opioid misuse. Preliminary analyses suggest a more appropriate threshold of identification is a score of ≥ 3 not ≥ 4. Future work will increase numbers of evaluable patients and examine other factors associated with opioid misuse.