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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 9 of 9 Research Studies Displayed
Enzinger AC, Ghosh K, Keating NL
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
This study looked at trends in opioid prescriptions for cancer patients near the end-of-life (EOL) defined as the 30 days before death or hospice enrollment. The authors looked at Medicare part D data from 2007 to 2017 for 270,632 Medicare fee-for-service decedents with poor prognosis cancers. During that time, the proportion of decedents with poor prognosis cancers receiving 1 or greater opioid prescriptions near EOL declined 15.5% and the proportion receiving 1 or greater long-acting opioid prescriptions declined 36.5% to 18.1%. The mean daily dose fell from 24.5%, from 85.6 morphine milligram equivalents per day (MMED) to 64.6. The total amount of opioids prescribed fell from 1,075 morphine milligram equivalents per decedent to 666 morphine milligram equivalents per decedents. At the same time, the proportion of patients with pain-related ED visits increase 50.8% from 13.2% to 19.9%.
Citation: Enzinger AC, Ghosh K, Keating NL . US trends in opioid access among patients with poor prognosis cancer near the end-of-life. J Clin Oncol 2021 Sep 10;39(26):2948-58. doi: 10.1200/jco.21.00476..
Keywords: Cancer, Opioids, Palliative Care, Pain, Access to Care, Medication, Practice Patterns
Eyrich NW, Sloss KR, Howard RA
Opioid prescribing exceeds consumption following common surgical oncology procedures.
Researchers aimed to compare opioid prescribing to opioid consumption for common surgical oncology procedures. They found that the median quantity of opioid prescribed was significantly larger than consumed following breast biopsy, lumpectomy, and mastectomy or wide local excision. The majority of patients reported receiving education on taking opioids, but only 27% received instructions on proper disposal; 82% of prescriptions filled resulted in unused opioids, and only 11% of these patients safely disposed of them. They concluded that their study demonstrated that opioid prescribing exceeds consumption following common surgical oncology procedures, thus indicating the potential for reductions in prescribing.
Citation: Eyrich NW, Sloss KR, Howard RA . Opioid prescribing exceeds consumption following common surgical oncology procedures. J Surg Oncol 2021 Jan;123(1):352-56. doi: 10.1002/jso.26272..
Keywords: Opioids, Medication, Surgery, Cancer: Breast Cancer, Cancer, Practice Patterns, Pain
Brown TJ Keshvani, N Gupta, et al.
Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study.
This study examined trends in the use of laxatives for opioid-induced constipation (OIC) in patients prescribed opioids for cancer pain treatment. A retrospective study was conducted of lung cancer patients seen in the Veteran’s Affair system from 2003 to 2016. There were 130,990 individuals included in the analysis. The majority (87%) received no prophylaxis (75%) or received docusate alone while 5% received OIC prophylaxis with the unnecessary addition of docusate. Throughout the study period, laxative prescription significantly decreased while categories of OIC prophylaxis were unchanged. The study concluded that almost 90% received inadequate or inappropriate OIC prophylaxis.
Citation: Brown TJ Keshvani, N Gupta, et al.. Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study. Support Care Cancer 2020 Nov;28(11):5315-21. doi: 10.1007/s00520-020-05364-6..
Keywords: Cancer: Lung Cancer, Cancer, Veterans, Opioids, Medication, Prevention, Pain
Azad AD, Bozkurt S, Wheeler AJ
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
This study analyzed the relationship between differing breast cancer excisional procedures, reconstruction, and short-term pain outcomes. Women who underwent breast cancer surgery with and without reconstruction were included from two institutions: an academic hospital (AH) and a Veterans Health Administration (VHS) facility. Average pain scores at time of discharge and at 30-day follow-up were analyzed. The study included 1402 patients at AH and 1435 at VHA. Of those, 425 AH and 165 VHA patients underwent breast reconstruction. Pain scores were highest at discharge and improved over time. Younger age, preoperative opioid use, and longer length of stay were all associated with worse pain scores.
Citation: Azad AD, Bozkurt S, Wheeler AJ . Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes. J Surg Oncol 2020 Sep 15;122(4):623-31. doi: 10.1002/jso.26070..
Keywords: Pain, Cancer: Breast Cancer, Cancer, Surgery, Outcomes, Women
Lou I, Chennell TB, Schaefer SC
Optimizing outpatient pain management after thyroid and parathyroid surgery: a two-institution experience.
This study aimed to describe the outpatient narcotic medication needs for patients undergoing thyroid and parathyroid surgery, and to identify predictors of higher requirement. It concluded that overall, 93 percent of patients undergoing thyroidectomy and parathyroidectomy require 20 or fewer oral morphine equivalents by their postoperative visit.
Citation: Lou I, Chennell TB, Schaefer SC . Optimizing outpatient pain management after thyroid and parathyroid surgery: a two-institution experience. Ann Surg Oncol 2017 Jul;24(7):1951-57. doi: 10.1245/s10434-017-5781-y.
Keywords: Cancer, Medication, Pain, Patient-Centered Outcomes Research, Surgery
Rocque GB, Halilova KI, Varley AL
Feasibility of a telehealth educational program on self-management of pain and fatigue in adult cancer patients.
The primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. The program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50 percent of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy.
Citation: Rocque GB, Halilova KI, Varley AL . Feasibility of a telehealth educational program on self-management of pain and fatigue in adult cancer patients. J Pain Symptom Manage 2017 Jun;53(6):1071-78. doi: 10.1016/j.jpainsymman.2016.12.345.
Keywords: Cancer, Pain, Education: Patient and Caregiver, Patient Self-Management, Telehealth
Perone JA, Riall TS, Olino K
Palliative care for pancreatic and periampullary cancer.
This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.
Citation: Perone JA, Riall TS, Olino K . Palliative care for pancreatic and periampullary cancer. Surg Clin North Am 2016 Dec;96(6):1415-30. doi: 10.1016/j.suc.2016.07.012.
Keywords: Cancer, Palliative Care, Pain, Decision Making
Kenzik K, Pisu M, Johns SA
Unresolved pain interference among colorectal cancer survivors: Implications for patient care and outcomes.
This study describes pain interference (PI) prevalence across the cancer continuum; 2) identifies demographic and clinical factors associated with PI and changes in PI; and 3) examines PI’s relationship with survivors’ job changes. It concluded that almost half of survivors with PI during the initial phase of care had continued PI into posttreatment. Comorbidities, especially cardiovascular and pulmonary conditions, contributed to continued PI.
Citation: Kenzik K, Pisu M, Johns SA . Unresolved pain interference among colorectal cancer survivors: Implications for patient care and outcomes. Pain Med 2015 Jul;16(7):1410-25. doi: 10.1111/pme.12727..
Keywords: Cancer, Cancer: Colorectal Cancer, Quality of Life, Pain, Patient-Centered Outcomes Research
Martinez KA, Aslakson RA, Wilson RF
A systematic review of health care interventions for pain in patients with advanced cancer.
The authors sought to synthesize the evidence on the effectiveness of pain-focused interventions in patients with advanced cancer. In nineteen studies, they found moderate strength of evidence that pain management in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
Citation: Martinez KA, Aslakson RA, Wilson RF . A systematic review of health care interventions for pain in patients with advanced cancer. Am J Hosp Palliat Care 2014 Feb;31(1):79-86. doi: 10.1177/1049909113476129.
Keywords: Cancer, Comparative Effectiveness, Pain, Palliative Care, Quality Improvement