A Delicate Balance: Treating Cancer in the Midst of the Opioid Epidemic

EXTRA VIGILANCE, CAREFUL MANAGEMENT and emphasizing empathy can make treatment for cancer pain more effective during an opioid addiction epidemic, said Judith A. Paice, Ph.D., RN, during a presentation at the 19th Annual Lynn Sage Breast Cancer Symposium, in September.

Although it’s understandable in the current climate that both patients and physicians might approach opioid use with extra caution, this may be excessive in some cases, said Paice, director of the Cancer Pain Program and a research professor of medicine at Northwestern University’s Feinberg School of Medicine, and past president of the American Pain Society. More patients than ever are living with pain. As of 2012, there were 32.6 million people worldwide living with cancer, and that number is expected to jump to 52.2 million by 2030, according to the International Agency for Research on Cancer.

Improvements in cancer treatment have led to millions of patients surviving for a decade or more, with a corresponding increase in the number who live with pain. Paice cited a review published in Pain, estimating that 40 percent of cancer survivors live with some degree of pain and that 5 to 10 percent have severe chronic pain that limits their ability to function. One in five childhood cancer survivors reports pain.

Amid the discussion about opioid overuse, Paice is concerned that some patients remain undertreated due to addiction fears that do not match the evidence. “After (the singer) Prince died, people asked me to take them off their fentanyl patches, and I had to reassure them that Prince hadn’t died from a fentanyl patch,” she said. Although long-term opioid addiction often begins with the use of prescription painkillers like oxycodone, Paice cited research showing that three of four such addicts acquired those pills illicitly rather than through a legitimate prescription.

The Centers for Disease Control issued guidelines for opioid treatment last year, and Paice said that both primary care physicians and insurance companies sometimes treat them as a mandate, even though they may be too conservative to be applied to cancer-related pain. “Many of us protested the recommendation that…