The Opioid Crisis and Radiation Therapy: A Patient Survey to Identify Best Practices for Pain Management.

PURPOSE/OBJECTIVE(S): The American opioid epidemic has reached a critical point in our nation's history. Long-term opioid use among cancer survivors is associated with a variety of worse long-term outcomes. We used a questionnaire to evaluate patient perspectives of their pain control during radiation in our department. It aimed to ascertain patient understanding of opioid prescribing practices and alternative pain control methods.

MATERIALS/METHODS: The questionnaire was based on the revised American Pain Society Patient outcome questionnaire. The survey was composed of 16 questions focusing on pain levels during radiation, interference with daily activities, effect on mood and emotions, alternative pain treatment methods, and opioid amount prescribed. The data was collected from patients with a head and neck cancer diagnosis who completed radiation treatment between May 2020 and January 2021. The survey was completed at their one-month follow-up visit. Data is recorded using descriptive statistics.

RESULTS: We collected data from 60 patients. Using a 10-point scale, patients on average reported a 5.3 as the worst level of pain during radiation therapy. Pain at the one-month follow-up dropped down to a 2.1 average. During radiation, patients reported having severe pain 28% of a 24 hour/day timeframe. Patients reported 69% pain relief with their current pain regimen. Patients reported an average of 7.5 feeling like they were involved with their pain treatment decisions. Using a 10-point scale, patients were fairly satisfied with their pain management with an average response of 7.7. Of the patients surveyed, 52 (87%) reported that they received information about their pain treatment options. Only 44 (73%) of the patients used non-medicine methods to relieve their pain. On average they used 2.3 other techniques included meditation, listening to music, prayer, relaxation, walking, watching TV, reading, heat/cold, massage. Thirty-eight percent of patients reported never having a nurse or doctor discuss non-medication methods, 40% said sometimes, and 22% said often. In the survey, 72% of patients reporting using non-narcotic medication such as Tylenol or Ibuprofen. Of the 50 patients who were prescribed opioid analgesics, 24 (48%) had medication left over. On average, patients had 13 tablets left over. Of the 24 patients, 15 said they simply "kept" the medication and 9 said they "threw it away".

CONCLUSION: We aim for all providers to include patients in creating a personalized pain management plan. Better education needs to be provided to patients to help them build a foundation of pain control with non-opioid medications and techniques. Oncology patients are at particular high risk of prolonged opioid use/abuse. Patient education and prescription guidelines are paramount to improve patient perception of the need for opioids and alternatives to their pain control. These survey results will act as a cornerstone in developing these guidelines for a radiation oncology department.