Impact of Voluntary Opioid Taper Program in Cancer Survivors (FR460B)

Abstract

•Identify the challenges and risks related to long-term opioid therapy in cancer patients.•Characterize a successful voluntary opioid taper program in an outpatient palliative care clinic. ASCO Clinical Practice Guidelines for the management of chronic pain in cancer survivors recommend reducing or discontinuing opioids when no longer warranted, although if and how this can be achieved in practice is unknown. We examined the feasibility, impact, and best practices of a voluntary outpatient opioid taper program in cancer survivors on long-term opioid therapy (LTOT) for chronic pain. Eligible patients were followed in an NCI-designated Comprehensive Cancer Center. A retrospective chart review using electronic medical records was conducted in patients whose opioid dose was tapered between October 1, 2013, and April 30, 2018. Demographics, clinical data, and detailed pain regimens were collected. Statistical analyses were conducted to characterize the time from taper initiation to the lowest achieved dose, and to explore the relationships between dose reduction and independent variables. Opioid dose reduction was achieved in 162 (82%) out of 196 patients offered a voluntary taper. 119 (74%) of patients who were tapered had equal or greater than a 50% dose reduction. The average pain scores at baseline and at the time of the lowest tapered dose were unchanged. Less than 10% of patients reported withdrawal symptoms. An initial opioid dose of > 500 oral morphine equivalents at baseline was an independent predictor of a smaller percentage of taper. The presence of a co-morbid psychiatric condition and adjuvant co-analgesics did not significantly affect the amount of the taper. A clinically meaningful and well-tolerated opioid taper is feasible in cancer survivors on LTOT.