TY - JOUR
T1 - Use of Opioids for Adults With Pain From Cancer or Cancer Treatment
T2 - ASCO Guideline
AU - Paice, Judith A
AU - Bohlke, Kari
AU - Barton, Debra
AU - Craig, David S
AU - El-Jawahri, Areej
AU - Hershman, Dawn L
AU - Kong, Lynn R
AU - Kurita, Geana P
AU - LeBlanc, Thomas W
AU - Mercadante, Sebastiano
AU - Novick, Kristina L M
AU - Sedhom, Ramy
AU - Seigel, Carole
AU - Stimmel, Joanna
AU - Bruera, Eduardo
PY - 2023/2/1
Y1 - 2023/2/1
N2 - PURPOSE: To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults.METHODS: A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations.RESULTS: The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time.RECOMMENDATIONS: Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management.Additional information is available at www.asco.org/supportive-care-guidelines.
AB - PURPOSE: To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults.METHODS: A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations.RESULTS: The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time.RECOMMENDATIONS: Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management.Additional information is available at www.asco.org/supportive-care-guidelines.
KW - Adult
KW - Analgesics, Opioid/adverse effects
KW - Cancer Pain/drug therapy
KW - Humans
KW - Neoplasms/complications
KW - Pain Management
KW - Pain/drug therapy
KW - Substance-Related Disorders/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85147089339&partnerID=8YFLogxK
U2 - 10.1200/JCO.22.02198
DO - 10.1200/JCO.22.02198
M3 - Review
C2 - 36469839
SN - 0732-183X
VL - 41
SP - 914
EP - 930
JO - Journal of clinical oncology : official journal of the American Society of Clinical Oncology
JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology
IS - 4
ER -