Guidelines Conflict for Long-Term Opioid Tx in Cancer Survivors
Inconsistencies exist between CDC and NCCN opioid guideline recommendations.
(HealthDay News) -- Evidence is lacking about the need for and outcomes of long-term opioid therapy in cancer survivors, and contemporary guidelines offer conflicting recommendations, according to a viewpoint article recently published online in JAMA Oncology.
Noting that long-term opioid therapy use is prevalent among cancer survivors, Salimah H. Meghani, PhD, and Neha Vapiwala, MD, from the University of Pennsylvania in Philadelphia, report on areas where the US Centers for Disease Control and Prevention guidelines for prescribing opioids cause confusion for oncology clinicians.
The authors note that the CDC opioid guidelines distinguish between patients with cancer undergoing treatment, to whom the guidelines do not apply, and those who have completed treatment, to whom they do apply, although pain levels are similar for both groups. Inconsistencies are noted in the CDC opioid guidelines and the National Comprehensive Cancer Network guidelines used by oncology clinicians, with the latter recommending long-acting opioid formulations and supplemental short-acting opioids in combination with long-acting opioids. The CDC opioid guidelines prefer non-pharmacologic therapy and non-opioid pharmacologic therapy for chronic pain, but robust evidence is lacking on the role of non-pharmacologic interventions in patients with cancer.
"This lack of evidence, coupled with conflicting and competing contemporary guidelines from diverse authoritative agencies and organizations, carries the potential to confuse, if not seriously jeopardize, pain management for patients with cancer who are living with moderate-to-severe pain, adding to an already appalling burden of unrelieved cancer pain," the authors write.
Meghani SH and Vapiwala N. Bridging the Critical Divide in Pain Management Guidelines From the CDC, NCCN, and ASCO for Cancer Survivors. JAMA Oncol. [Published online May 31, 2018.] doi:10.1001/jamaoncol.2018.1574