Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

Figures & data

Table 1 Studies of screening questionnaires for opioid-misuse or -abuse risk

Study	Population	Sample size	Study design	Questionnaire	Results
Ehrentraut et al^Citation42	Young adults, St Jude Children’s Research Hospital, Memphis, USA	n=38	Prospective study	SOAPP-R	23 patients identified as standard risk, with none developing aberrant opioid-use behaviors 15 patients classified as high risk, with five displaying “red-flag behaviors” Classification of high risk based on either psychology interview and SOAPP-R together or psychology interview alone
Barclay et al^Citation40	Current or past diagnosis of solid and blood cancers, palliative care clinic, University of Virginia, Charlottesville, USA	n=114	Retrospective chart review	ORT	Mean ORT score 3.79, 57% low risk, 22% medium risk, and 21% high risk Common risk factors age (16–45 years old), personal history of alcohol or illicit drugs Most ORT scores calculated using chart data, 31% had documented ORT in clinic notes
Bruera et al^Citation24	Advanced solid and blood cancers, outpatient symptom-control clinic, Cross Cancer Institute, Edmonton, Canada	n=166	Retrospective chart review	CAGE	25% scored CAGE-positive on first visit
Bruera et al^Citation25	Advanced solid and blood cancers, inpatient palliative care unit, Edmonton, Canada	n=200	Retrospective chart review	CAGE	27% CAGE-positive Higher opioid doses on admission and day 2, but pain intensity and maximal opioid dose no different between CAGE-positive and -negative
Bruera et al^Citation27	Advanced cancer, inpatient palliative care unit and hospice, Edmonton, Canada	n=988	Retrospective chart review	CAGE	Patients admitted to palliative care unit had higher positive CAGE score than hospice (27% vs 16%)
Childers et al^Citation37	Solid and blood cancers, supportive care clinic, Hillman Cancer Center, Pittsburgh, USA	n=323	Retrospective chart review	CAGE, SOAPP-SF	46% of new patients (76) had positive SOAPP-SF scores and 15% positive CAGE scores Those with positive SOAPP-SF scores tended to be younger
Chow et al^Citation21	Solid cancer, radiotherapy outpatient clinic, Toronto Sunnybrook Regional Cancer Center, Toronto, Canada	n=128	Retrospective chart review	CAGE	9 patients had positive CAGE scores No difference in pain intensity or analgesic use in CAGE-positive
Dev et al^Citation28	Advanced solid and blood cancers, supportive care clinic, MD Anderson, Houston, USA	n=598	Retrospective chart review	CAGE	100 CAGE-positive patients younger, male, history of tobacco, actively using nicotine, history of illegal recreational drug use
Jenkins et al^Citation23	Advanced solid and blood cancers, inpatient palliative care consults, Edmonton, Canada	n=95	Retrospective chart review	CAGE	24% positive CAGE score
Jenkins et al^Citation26	Advanced solid and blood cancers, palliative care unit, Edmonton, Canada	n=96	Retrospective chart review	CAGE	12 of 69 patients had positive CAGE scores
Koyyalagunta et al^Citation36	Current and past solid and blood cancers, pain outpatient clinic, MD Anderson, Houston, USA	n=522	Retrospective chart review	SOAPP-SF	149 high risk (score ≥4) = younger, higher pain score 283 history of alcohol use, with 27% currently using 289 history of smoking, with 19% actively smoking 68 patients had history of illicit drug use Ongoing illicit drug SOAPP-SF score mean 9.625 High risk = high morphine-equivalent daily dose
Kwon et al^Citation30	Head and neck cancer with curative treatment, MD Anderson, Houston, USA	n=70	Retrospective chart review	CAGE	44 patients continued opioids 3 months after radiation 23 patients continued opioids 6 months after radiation 18 nonstoppers, three stoppers were CAGE-positive
Kwon et al^Citation29	Advanced cancer, MD Anderson Houston, USA	n=432	Prospective study	CAGE	76 patients diagnosed as chemically coping CAGE positivity, younger age, better performance status, pain = predictors of chemical coping Documentation of chemical coping significantly lower in medical records than diagnosed by physicians
Ma et al^Citation39	Solid and blood cancer, sickle cell, Comprehensive Cancer Center, San Diego, USA	n=114: 107 cancer, 7 sickle	Retrospective chart review	ORT	65 patients low risk, 21 moderate risk, 28 high risk No differences between risk groups based on age, sex, metastases, pain score. or cancer type Risk factors = family history of alcohol abuse and history of depression
Martin et al^Citation22	Preoperative, upper digestive tract, Berlin, Germany	n=705	Prospective study	CAGE	Prevalence of alcohol misuse 81% 64% of patients diagnosed with CAGE
Mercadante et al^Citation20	Advanced solid and blood cancers, palliative care unit and home care, cancer center, Palermo, Italy	n=443	Prospective study	CAGE	18 (4%) patients CAGE-positive CAGE-positive more likely to be male and younger
Parsons et al^Citation32	Advanced solid and blood cancers, supportive care clinic, MD Anderson, Houston, USA	n=665	Retrospective chart review	CAGE	100 CAGE-positive CAGE-positive = younger, male, head/neck cancer Pain worse at baseline among CAGE-positive patients More CAGE-positive patients on opioids at first visit
Pelkofski et al^Citation41	Gynecologic cancer, oncology or palliative care clinic, University of Virginia, Charlottesville, USA	n=53	Retrospective chart review, abstract	ORT	Mean ORT score 2.1 79% low risk, 13% moderate risk, and 7.5% high risk 23% admitted to personal history of illegal drug, prescription drug, or alcohol abuse Younger patients at high risk for increased ORT score
Reddy et al^Citation31	Advanced solid cancers, supportive care clinic, MD Anderson, Houston, USA	n=300	Prospective survey	CAGE	58 patients CAGE-positive and 26 history of illicit drugs 56 patients stored opioids in plain sight, 208 patients hid opioids but unlocked, and 28 locked their opioids CAGE-positive patients and those with history of illicit drug use or smoking more likely to lock their opioids
Wattana et al^Citation35	Emergency department, MD Anderson, Houston, USA	n=70	Prospective study, abstract	SOAPP-R	27 of 65 patients positive SOAPP-R scores SOAPP-positive patients = higher number of prescriptions from higher number of providers and filled at more pharmacies

Abbreviations: SOAPP-R, Screener and Opioid Assessment for Patients with Pain – revised; ORT, Opioid Risk Tool; CAGE, Cut Down, Annoyed, Guilty, and Eye-Opener; SF, short form.

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