ABSTRACT/ PROJECT SUMMARY
Pain is one of the top symptoms producing the greatest negative impact on cancer patients' quality of life.
Unfortunately, one in three cancer patients will experience moderate to severe pain due to consequences of
cancer, its treatments or both. For one in three, pain will persist after completion of active cancer treatments.
With 15.5 million Americans living with cancer, this is a substantial public health matter. While many
complementary and alternative medicine approaches exist, their clinical use for cancer pain remains seriously
hampered by lack of robust evidence, short-term relief, and excessive out-of-pocket costs. In turn, opioid pain
medications are prescribed to cancer patients – who notably, also remain excluded from most state and policy
initiatives on opioids. Long-term (>3
months
) opioid therapy is also prevalent among cancer outpatients when
compared to age-sex matched controls. Despite this, cancer patients have been almost invariably
excluded
from
T
he recent Health
management”
studies investigating the outcomes of long-term opioid therapy and use.
and Human
Services Pain Management Inter-Agency Taskforce has identified “self-
as one of the best practices in improving chronic pain. However,interventions cannot be
designed due to serious gaps in our current understanding of cancer outpatients' pain self-management and
especially their opioid self-management. Recent systematic reviews demonstrate that most cancer pain
interventions (based on knowledge translation and conducted predominantly or exclusively with White patients)
improve knowledge, but largely do not improve outcomes that matter to patients such as daily pain, function, or
quality of life. This underscores a need to continue in search of other targets for intervention development. This
6-month prospective cohort study will generate new knowledge about longitudinal pain, opioid self-
management trajectories, and associated outcomes among cancer outpatients in the context of daily pain, pain
flares, key clinical moderators and covariates. A total of 400 cancer outpatients (50% African Americans; 50%
women) who are prescribed long-acting (LA) opioids will be recruited from three urban oncology centers.
Longitudinal opioid self-management patterns will be captured in real-time using medication event monitoring
system (MEMS®). Daily background pain, pain flares, and use of “as-needed” opioids will be collected using
the self-report tracker (SRT®). Patient-reported outcomes (PRO) to be assessed are changes in pain levels,
function, sleep, and health-related quality of life. Health services outcomes include unplanned hospitalizations
and emergency department use (healthcare utilization). This study will supply rigorous data, comprehensive
set of sociodemographic and clinical covariates, and key moderators upon which further research for pain-self
management best practices can be based, including targets to ameliorate racial disparities. Overall, this
research can have a sustained impact on the science of cancer pain management.