| Sumario: | Symptom Management and Palliative Care Significance & Background: Symptoms of pain are a common experience for many patients undergoing active treatment of disease and living with metastatic or advanced cancer. The use of opioids remains a common pharmacologic therapy utilized for the management of moderate to severe pain. However, the chronic nature of cancer-related pain has caused many providers to also consider the potential harm with long-term use. Prolonged use of opioids has been negatively associated with an increased risk for both drug tolerance and dependency, thus contributing to a growing problem of opioid misuse in some cancer survivors. Purpose: Previous recommendations for the screening and treatment of opioid use disorder (OUD) have traditionally excluded patients with cancer. Yet, there has been a steady rise in the prevalence of OUD within a diverse population of cancer survivors, which includes individuals from varying age groups, socioeconomic backgrounds, and many living with other chronic conditions. The early identification of survivors at risk is key to effectively address the complexities opioid dependence, reduce the risk of opioid misuse, and the potential for opioid-related death. Interventions: By implementing a patient centered approach, nurses can effectively support survivors in the evaluation of their pain symptoms while also assessing for opioid dependence. A comprehensive review of the patient's experience with pain during each clinical encounter was initiated in an outpatient setting of an academic medical center. Results: The Numeric Pain Rating Scale, Verbal Rating Scale, and Brief Pain Inventory are provided to the patient during the appointment check-in process. A review of all prescribed, over-the-counter medications, and supplements taken for pain is conducted during the patient encounter. The provider also notes the current pattern of use, reviews the patient's perception of the overall effectiveness of the pain regimen, level of activity tolerance, and any attempts to decrease their usage of opioids. All patients reporting symptoms or presenting with physical signs of withdrawal undergo additional screening with the COWS Score for Opiate Withdrawal. Discussion: The screening for OUD should be patient centered, compassionate, and a nonjudgmental process. Early intervention by a multi- disciplinary team allows the patients presenting with signs of dependency and OUD to gain timely access to supportive resources and medical treatment. Achieving optimal pain control can be challenging, but with open communication and shared decision-making cancer survivors can achieve a better quality of life.
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