Ms. Parikh
Clinical question: What are expert recommendations for the use of opioids for adults with pain from cancer?
Background: Pain is a common consequence of cancer and cancer treatment. There are limited guidelines focused solely on opioid use in a patient with cancer.
Study design: The evidence base included 31 systematic reviews and 16 randomized controlled trials published between January 1, 2010, and February 17, 2022.
Synopsis: The American Society of Clinical Oncology convened a multidisciplinary expert panel to formulate clinical practice guidelines for opioid initiation, titration, prevention, and management of opioid adverse effects in people with cancer or treatment-related pain.
Key points:
- For patients with moderate to severe cancer pain, opioids should be initiated as an immediate release or as needed with ongoing assessment and frequent titration to establish an effective dose.
- Considerations of bioavailability, route of administration, and half-life should be made when selecting the initial opioid.
- Education and strategies should be provided to prevent known opioid-related adverse effects.
- Current evidence remains insufficient to recommend ranges for titrating opiates, specific short-acting opioids for breakthrough pain, and what to use in the setting of renal and hepatic impairment.
Bottom line: In patients with moderate to severe cancer pain, opioids effectively reduce pain and should be initiated as immediate release and titrated to establish an effective dose.
Citation: Paice JA, Bohlke K, et al. Use of opioids for adults with pain from cancer or cancer treatment: ASCO guideline. J Clin Oncol. 2023;41(4):914-30.
Ms. Parikh is a physician assistant and hospitalist on inpatient hematology/oncology primary service at Stanford Hospital, and an instructional faculty member at Stanford University’s School of Medicine’s physician assistant program in Stanford, Calif.