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Challenges in Managing Cancer Pain
1. Challenges in Managing
Cancer Pain
David S. Craig, PharmD
Pharmacist Lead – Supportive Care Medicine & Acute Pain
FLASCO Fall Session
Orlando, Florida
November 5th, 2016
2. 1. Discuss the new ASCO Policy Statement on
Opioid therapy and Access to Treatment
2. Identify barriers to pain management in the
cancer patient
3. Understand the role of the oncology
pharmacist or supportive care pharmacist in
managing cancer pain in the hospital setting
4. Understand the Joint commission (JC)
standards on pain management and apply
strategies on safe use of opioids in the hospital
setting
Objectives
4. ASCO: October 2016
Found at www.asco.org/advocacy-policy/policies-positions-guidance/policy-statements. Accessed 10//2016
5. 1. Cancer Patients Are a Special Population
– Cancer patients should be largely exempt from
regulations restricting access to or limiting doses of
prescription opioids in recognition of the unique nature of
their disease, its treatment, and potentially life-long
adverse health effects from having had cancer
2. Provider Education
– The ASCO statement recommends that providers have a
choice of sources of materials for opioid prescribing
education
ASCO Policy Statement 2016
Found at www.asco.org/advocacy-policy/policies-positions-guidance/policy-statements. Accessed 10//2016
6. 3. Patient Education
– Patient education on the medical use of opioids is best
provided by a health professional. The society supports
greater emphasis on safe storage and disposal of
prescription medication, and believes such efforts
should be strengthened.
4. Prescription Drug Monitoring Programs
– Providers who treat cancer-related pain may prescribe
relatively large numbers of opioids or provide multiple
controlled drugs at relatively high doses.
Found at www.asco.org/advocacy-policy/policies-positions-guidance/policy-statements. Accessed 10//2016
ASCO Policy Statement 2016
7. 5. Patient Screening and Assessment Before and
During Opioid Treatment
-- After the initial screening and assessment of patients
with cancer, the type and timing of subsequent
assessments should be determined by the treating
physician.
6. Abuse Deterrent Formulations
-- Depending on the clinical situation, the use of either an
abuse deterrent formulation or non-abuse deterrent
formulation of an opioid medication may be perfectly
appropriate.
Found at www.asco.org/advocacy-policy/policies-positions-guidance/policy-statements. Accessed 10//2016
ASCO Policy Statement 2016
8. 7. Treatment for Misuse, Abuse, or Addiction
-- Individuals with an opioid-related disorder should have rapid
access to appropriate assessment, diagnosis, and treatment,
regardless of the patient's payer or geographic setting
8. Wider Availability of Naloxone
-- ASCO supports increased access to naloxone--a
lifesaving medication in cases of opioid overdose by
patients, caregivers, and first responders
9. Prescription “Take-Back” Programs
-- Collection sites should be readily available to patients
Found at www.asco.org/advocacy-policy/policies-positions-guidance/policy-statements. Accessed 10//2016
ASCO Policy Statement 2016
9. Current Barriers for Cancer
Patients in Florida
• Lack of adequate supplies of opioids at
community pharmacies
• Fall out from efforts focused on reducing the
number of “Pill Mills”
– Negative perceptions are more common
– More scrutiny for all who take opioids
– Less interest by providers to engage in the
prescribing or dispensing of opioids
• National Pharmacy policies on “dispensing”
that stigmatize all patients on opioids
11. Potential Solutions
• Advocate for change when you identify
problems
• Engage local & community pharmacies, to
overcome negativity and barriers
• Encourage patients to speak up and speak
out about their experiences
• Work with Professional organizations like
FLASCO/ASCO, ACS, and others
