Article
Opioids and Cancer Survivors: Issues in Side-Effect Management
Purpose/Objectives: To describe the most common side effects associated with the use of opioid treatment in patients with moderate to severe cancer pain; to discuss research findings specific to the use of opioids for cancer pain in long-term cancer survivors.
Data Sources: Published research, articles from a literature review, and U. S. statistics.
Data Synthesis: Side effects associated with opioid use are a major contributor to patient reluctance to follow treatment plans for cancer pain. Clinicians must follow the critical steps necessary to build comprehensive treatment plans that include a preventive approach to side effects and opioid rotation when side effects do not resolve.
Conclusions: Side effects associated with long-term use of opioids by cancer survivors are a major contributor to patient reluctance to follow a cancer pain treatment plan. Patient education efforts must promote open and clear communication between survivors and their providers about side effects and other important issues related to long-term use of opioids in managing pain related to cancer and its treatment.
Implications for Nursing: Oncology nurses recognize that patients often require the long-term use of opioids when they experience chronic pain as a result of their disease or its treatment. The long-term physical and cognitive effects of such opioid use are not well known, despite the advances that have been made in cancer pain control and research. Survivors should communicate their concerns about side effects to the treatment team. In addition, patients and family members must be encouraged to inform their providers about personal attitudes, beliefs, and practices that may affect decisions about taking their analgesics as prescribed. Most importantly, oncology nurses must teach patients and their families to self-advocate for optimal pain relief with minimal side effects.
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References
Abs, R., Verhelst, J., Maeyaert, J., Van Buyten, J. P., Opsomer, F., Adriaensen, H., et al. (2000). Endocrine consequences of long-term intrathecal administration of opioids. Journal of Clinical Endocrinology and Metabolism, 85(6), 2215-2222.
American Pain Society. (2003). Principles of analgesic use in the treatment of acute pain and cancer pain (5th ed.). Glenview, IL: Author.
Anderson, K. O., Mendoza, T. R., Payne, R., Valero, V., Palos, G. R., Nazario, A., et al. (2004). Pain education for underserved minority cancer patients: A randomized controlled trial. Journal of Clinical Oncology, 22(24), 4918-4925.
Anderson, K. O., Richman, S. P., Hurley, J., Palos, G., Valero, V., Mendoza, T. R., et al. (2002). Cancer pain management among underserved minority outpatients: Perceived needs and barriers to optimal control. Cancer, 94(8), 2295-2304.
Balducci, L. (2006). Management of cancer in the elderly. Oncology, 20(2), 135-143.
Barsevick, A. M., Sweeney, C., Haney, E., & Chung, E. (2002). A systematic qualitative analysis of psychoeducational interventions for depression in patients with cancer. Oncology Nursing Forum, 29(1), 73-84.
Branford, R. A., Pantelidis, P., & Ross, J. R. (2008). Ethnic considerations in pharmacogenetic studies. Journal of Clinical Oncology, 26(10), 1766-1767.
Brant, J. M. (2001). Opioid equianalgesic conversion: The right dose. Clinical Journal of Oncology Nursing, 5(4), 163-165.
Cherny, N., Ripamonti, C., Pereira, J., Davis, C., Fallon, M., McQuay, H., et al. (2001). Strategies to manage the adverse effects of oral morphine: An evidence-based report. Journal of Clinical Oncology, 19(9), 2542-2554.
Choi, Y. S., & Billings, J. A. (2002). Opioid antagonists: A review of their role in palliative care, focusing on use in opioid-related constipation. Journal of Pain and Symptom Management, 24(1), 71-90.
Cleeland, C. S., Bennett, G. J., Dantzer, R., Dougherty, P. M., Dunn, A. J., Meyers, C. A., et al. (2003). Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer, 97(11), 2919-2925.
Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., et al. (2000). Assessing symptom distress in cancer patients: The M. D. Anderson Symptom Inventory. Cancer, 89(7), 1634-1646.
Comerford, D. (2008). Techniques of opioid administration. Anaesthesia and Intensive Care Medicine, 9(1), 21-26.
Daniell, H. W. (2002). Hypogonadism in men consuming sustained-action oral opioids. Journal of Pain, 3(5), 377-384.
Daut, R. L., Cleeland, C. S., & Flanery, R. C. (1983). Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain, 17(2), 197-210.
Dibble, S. L., Luce, J., Cooper, B. A., Israel, J., Cohen, M., Nussey, B., et al. (2007). Acupressure for chemotherapy-induced nausea and vomiting: A randomized clinical trial. Oncology Nursing Forum, 34(4), 813-820.
Dodd, M. J., Cho, M. H., Cooper, B., Miaskowski, C., Lee, K. A., & Bank, K. (2005). Advancing our knowledge of symptom clusters. Journal of Supportive Oncology, 3(6, Suppl. 4), 30-31.
Ezenwa, M. O., Ameringer, S., Ward, S. E., & Serlin, R. C. (2006). Racial and ethnic disparities in pain management in the United States. Journal of Nursing Scholarship, 38(3), 225-233.
Fahey, K. F., Rao, S. M., Douglas, M. K., Thomas, M. L., Elliott, J. E., & Miaskowski, C. (2008). Nurse coaching to explore and modify patient attitudinal barriers interfering with effective cancer pain management. Oncology Nursing Forum, 35(2), 233-240.
Ferrell, B. R., Virani, R., Smith, S., & Juarez, G. (2003). The role of oncology nursing to ensure quality care for cancer survivors: A report commissioned by the National Cancer Policy Board and Institute of Medicine [Online exclusive]. Oncology Nursing Forum, 30(1), E1-E11. Retrieved September 5, 2008, from http://ons.metapress.com/content/3k31602727q874h5/?p=bc474fb14dc3456593… http://ons.metapress.com/content/3k31602727q874h5/?p=bc474fb14dc345659353782355f62c83&pi=0
Fine, P. G., Miaskowski, C., & Paice, J. A. (2004). Meeting the challenges in cancer pain management. Journal of Supportive Oncology, 2(6, Suppl. 4), 5-22.
Gordon, D. B. (2006). Oral transmucosal fentanyl citrate for cancer breakthrough pain: A review. Oncology Nursing Forum, 33(2), 257-264.
Gordon, D. B. (2007). New opioid formulations and delivery systems. Pain Management Nursing, 8(3, Suppl.), S6-S13.
Gordon, D. B., Dahl, J., Phillips, P., Frandsen, J., Cowley, C., Foster, R. L., et al. (2005). The use of ‘as-needed’ range orders for opioid analgesics in the management of acute pain: A consensus statement of the American Society for Pain Management Nursing and the American Pain Society. Home Healthcare Nurse, 23(6), 388-396.
Gordon, D. B., Dahl, J. L., Miaskowski, C., McCarberg, B., Todd, K. H., Paice, J. A., et al. (2005). American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Archives of Internal Medicine, 165(14), 1574-1580.
Gordon, D. B., Stevenson, K. K., Griffie, J., Muchka, S., Rapp, C., & Ford-Roberts, K. (1999). Opioid equianalgesic calculations. Journal of Palliative Medicine, 2(2), 209-218.
Hadjistavropoulos, T., Herr, K., Turk, D. C., Fine, P. G., Dworkin, R. H., Helme, R., et al. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. Clinical Journal of Pain, 23(1, Suppl.), S1-S43.
Hewitt, M. E., Greenfield, S., Stovall, E., National Cancer Policy Board, & Committee on Cancer Survivorship: Improving Care and Quality of Life. (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
Im, E. O., Chee, W., Guevara, E., Liu, Y., Lim, H. J., Tsai, H. M., et al. (2007). Gender and ethnic differences in cancer pain experience: A multiethnic survey in the United States. Nursing Research, 56(5), 296-306.
Jacox, A., Carr, D. B., & Payne, R. (1994). New clinical-practice guidelines for the management of pain in patients with cancer. New England Journal of Medicine, 330(9), 651-655.
Jensen, M. K., Thomsen, A. B., & Hojsted, J. (2006). 10-year follow-up of chronic non-malignant pain patients: Opioid use, health related quality of life and health care utilization. European Journal of Pain, 10(5), 423-433.
Joint Commission on Accreditation of Healthcare Organizations. (2006). Pain assessment and management: An organizational approach. Oakbrook Terrace, IL: Joint Commission Resources.
Juarez, G., Ferrell, B., & Borneman, T. (1999). Cultural considerations in education for cancer pain management. Journal of Cancer Education, 14(3), 168-173.
Levin, D. N., Cleeland, C. S., & Dar, R. (1985). Public attitudes toward cancer pain. Cancer, 56(9), 2337-2339.
McNicol, E., Horowicz-Mehler, N., Fisk, R. A., Bennett, K., Gialeli-Goudas, M., Chew, P. W., et al. (2003). Management of opioid side effects in cancer-related and chronic noncancer pain: A systematic review. Journal of Pain, 4(5), 231-256.
Mercadante, S., & Bruera, E. (2006). Opioid switching: A systematic and critical review. Cancer Treatment Reviews, 32(4), 304-315.
Miaskowski, C. (2004). Psychoeducational interventions for cancer pain serve as a model for behavioral research. Communicating Nursing Research, 37, 51, 53-71.
Miaskowski, C. (2008). Patient education about cancer pain management: How much time is enough? Pain, 135(1-2), 1-2.
Miaskowski, C., Dodd, M., & Lee, K. (2004). Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute. Monographs, (32), 17-21.
Morrison, R. S., Wallenstein, S., Natale, D. K., Senzel, R. S., & Huang, L. L. (2000). "We don't carry that"—Failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. New England Journal of Medicine, 342(14), 1023-1026.
National Comprehensive Cancer Network. (2008). NCCN clinical practice guidelines in oncology™: Adult cancer pain [v.1.2008]. Retrieved May 29, 2008, from http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf
Naughton, M., & Homsi, J. (2002). Symptom assessment in cancer patients. Current Oncology Reports, 4(3), 256-263.
Paice, J. A. (2004). Assessment of symptom clusters in people with cancer. Journal of the National Cancer Institute. Monographs, 32, 98-102.
Paice, J. A. (2007). Pharmacokinetics, pharmacodynamics, and pharmacogenomics of opioids. Pain Management Nursing, 8(3, Suppl. 1), S2-S5.
Paice, J. A., Penn, R. D., & Ryan, W. G. (1994). Altered sexual function and decreased testosterone in patients receiving intraspinal opioids. Journal of Pain and Symptom Management, 9(2), 126-131.
Paice, J. A., Toy, C., & Shott, S. (1998). Barriers to cancer pain relief: Fear of tolerance and addiction. Journal of Pain and Symptom Management, 16(1), 1-9.
Palos, G. R., Cantor, S. B., Aday, L. A., Mendoza, T. R., Mobley, G. M., & Cleeland, C. S. (2006). An urban community's preferences for hypothetical outcomes of analgesic pain treatment. Journal of Pain and Symptom Management, 32(5), 470-477.
Palos, G. R., Mendoza, T. R., Cantor, S. B., Aday, L. A., & Cleeland, C. S. (2004). Perceptions of analgesic use and side effects: What the public values in pain management. Journal of Pain and Symptom Management, 28(5), 460-473.
Patanwala, A. E., Duby, J., Waters, D., & Erstad, B. L. (2007). Opioid conversions in acute care. Annals of Pharmacotherapy, 41(2), 255-266.
Portenoy, R. K., & Lesage, P. (1999). Management of cancer pain. Lancet, 353(9165), 1695-1700.
Portenoy, R. K., Payne, R., Coluzzi, P., Raschko, J. W., Lyss, A., Busch, M. A., et al. (1999). Oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in cancer patients: A controlled dose titration study. Pain, 79(2-3), 303-312.
Rajagopal, A., Vassilopoulou-Sellin, R., Palmer, J. L., Kaur, G., & Bruera, E. (2004). Symptomatic hypogonadism in male survivors of cancer with chronic exposure to opioids. Cancer, 100(4), 851-858.
Reyes-Gibby, C. C., Wu, X., Spitz, M. R., Kurzrock, R., Fisch, M., Bruera, E., et al. (2008). Molecular epidemiology, cancer-related symptoms, and cytokines pathway. Lancet Oncology, 9(8), 777-785.
Rhiner, M., & Kedziera, P. (1999). Managing breakthrough cancer pain: A new approach. Home Healthcare Nurse, 17(6, Suppl.), 1-12.
Ross, J. R., Riley, J., Taegetmeyer, A. B., Sato, H., Gretton, S., du Bois, R. M., et al. (2008). Genetic variation and response to morphine in cancer patients: Catechol-O-methyltransferase and multidrug resistance-1 gene polymorphisms are associated with central side effects. Cancer, 112(6), 1390-1403.
Tamayo, A. C., & Diaz-Zuluaga, P. A. (2004). Management of opioid-induced bowel dysfunction in cancer patients. Supportive Care in Cancer, 12(9), 613-618.
Tatrow, K., & Montgomery, G. H. (2006). Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis. Journal of Behavioral Medicine, 29(1), 17-27.
Villars, P., Dodd, M., West, C., Koetters, T., Paul, S. M., Schumacher, K., et al. (2007). Differences in the prevalence and severity of side effects based on type of analgesic prescription in patients with chronic cancer pain. Journal of Pain and Symptom Management, 33(1), 67-77.
Wells, N., Murphy, B., Douglas, S., & Yelton, N. (2005). Establishing the safety and efficacy of an opioid titration protocol. Journal of Opioid Management, 1(1), 41-48.
West, C. M., Dodd, M. J., Paul, S. M., Schumacher, K., Tripathy, D., Koo, P., et al. (2003). The PRO-SELF©: Pain Control Program—An effective approach for cancer pain management. Oncology Nursing Forum, 30(1), 65-73.
Woolery, M., Bisanz, A., Lyons, H. F., Gaido, L., Yenulevich, M., Fulton, S., et al. (2008). Putting Evidence Into Practice®: Evidence-based interventions for the prevention and management of constipation in patients with cancer. Clinical Journal of Oncology Nursing, 12(2), 317-337.
World Health Organization. (1996). Cancer pain relief: With a guide to opioid availability (2nd ed.). Geneva, Switzerland: Author.
Zech, D. F., Grond, S., Lynch, J., Hertel, D., & Lehmann, K. A. (1995). Validation of World Health Organization guidelines for cancer pain relief: A 10-year prospective study. Pain, 63(1), 65-76.