Abstract
1. Identify the interacting difficulties of patients with cancer and opioid use disorder
2. Identify roles for palliative care in the interdisciplinary management of patients with cancer and opioid use disorder
Concomitant opioid use disorder (OUD) or nonmedical opioid use (NMOU) is a common problem among patients with cancer. However, little is known about optimal ways to manage pain and reduce the risk of harm for these patients. Additionally, the role of palliative care providers in this management is variable.
We aimed to develop interdisciplinary meetings to co-manage patients with cancer and OUD or concern for NMOU and identify patients in these meetings for specialist palliative care management.
We began 1-hour weekly meetings with representatives from oncology, addiction medicine, palliative care, cancer survivorship, social workers, nurses, and pharmacists. Patients with current or prior cancer and any clinician concern for OUD or NMOU were referred to this team to develop interdisciplinary plans for comprehensive management. Team members then met individually or jointly with patients in clinical encounters to discuss and enact the plans with patient support. Patient demographics, OUD, and palliative care encounter information were abstracted from the medical record and evaluated via descriptive statistics.
From September 2019 to June 2021, 60 patients were referred for interdisciplinary management. Of these, 36 (60%) were seen subsequently in a palliative care clinic. Among patients seen by palliative care, the most common malignancy was lung cancer (13, 36%). Most patients had stage IV cancer (26, 72%); however, some patients had early-stage or nonactive cancer (9, 15%). The majority had active OUD (20, 57%), and many were not on medication for opioid use disorder (MOUD) at referral (12, 40%). A large proportion received opioids for pain at the time of referral (29, 81%).
Palliative care played a key role in the management of OUD/NMOU in patients with cancer. Early findings point to an expanded role for PC, and future Plan-Do-Study-Act cycles will focus on formal screening, outreach in oncology clinics, and initiation of MOUD.