Symposia Abstracts

Symposium Chair: Sitara de Gagne, Patient Partner, Toronto, Ontario, Canada, sitaradegagne@hotmail.comSymposium Abstract: North America is in the midst of a public health emergency related to opioid use, referred to as the “opioid crisis”. Opioids play an important role in the management of cancer pain. However, the crisis and subsequent mitigation efforts (e.g., dose restrictions, forced tapers) have had unintended consequences, such as reluctance of patients to take and clinicians to prescribe opioids, and stigma felt by patients and expressed by providers. With the current global pandemic, cancer patients are faced with a crisis within a crisis, with increased opioid-related harms, re-routed cancer services resulting in fragmented or diminished access to care, and reduced opioid prescribing. This workshop will describe the nature and extent of the problem of inadequate cancer pain management amidst the dual public health emergencies of the North American opioid crisis and COVID-19 pandemic across contexts (e.g., United States, Canada), age groups (e.g., children to older adults) and perspectives (e.g., providers, researchers, patients and caregivers). First, J. Paice will discuss the challenge of cancer pain management within the United States opioid epidemic and COVID-19 and evidence-based strategies to mitigate opioid-related risks. Then, L. Gauthier will describe the Canadian response, including the outcomes of 2 national stakeholder meetings and findings from a Delphi study to identify key research questions to drive this field forward. Next, P. Tutelman will present quantitative and qualitative data outlining barriers to pediatric cancer pain management amidst the crises. Finally, S. de Gagne will provide a patient perspective as the parent of a childhood cancer survivor.Speaker 1: Judith A. Paice, PhD, RN, Northwestern University, Feinberg School of Medicine, Cancer Pain Program, Chicago, IL, USA, J-Paice@northwestern.edu, @JPaicePhDSpeaker 1 Abstract Title: Balancing Cancer Pain Management During the Time of an Opioid EpidemicSpeaker 1 Abstract: Cancer pain is a complex, bio-psycho-social-spiritual phenomenon with causes ranging from the direct effects of the tumor, to the consequences of cancer treatment, along with pre-existing painful conditions. Throughout the trajectory of cancer care, opioid use is often indicated and in fact, it may be unethical to limit or prohibit the use of opioids when pain is severe. While many patients can safely use these agents, the intersection of the unprecedented opioid epidemic, COVID-19 pandemic, and cancer pain further complicates care. Although prescription opioids were originally the source of diversion and misuse during the early years of this epidemic, currently monthly initial prescriptions are decreasing. This is in part due to enhanced education of prescribers but an unintended consequence of attention to this epidemic is that a large number of prescribers are no longer prescribing opioids, potentially limiting access to opioids for those in pain, including people with cancer. Oncologists face the significant challenge of providing cancer pain control that is safe and effective, while limiting individual risk for abuse or overdose and keeping the community free of diverted substances. Most oncology providers report inadequate training in chronic pain principles and in managing addiction. The COVID-19 pandemic has further exacerbated the challenge of cancer pain management by reducing access to integrative and interventional therapies and yielding pain drug shortages. Risk assessment and mitigation measures can be incorporated within oncology care to enhance effective pain management while reducing the potential for harm.Speaker 2: Perri Tutelman, BHSc. (Hons), Dalhousie University, Psychology and Neuroscience, Halifax, NS, Canada, ptutelman@dal.ca, @PerriTutelmanSpeaker 2 Abstract Title: Children’s Cancer Pain Management in the Era of the Opioid Crisis: Attitudes, Beliefs, and Barriers to Effective TreatmentSpeaker 2 Abstract: Children and their parents consistently report that pain is one of the most common and distressing symptoms of a cancer diagnosis. While there are effective pharmacological, psychological, and physical strategies to alleviate cancer-related pain, many children continue to report undertreated pain across the cancer continuum. This presentation will provide an overview of the problem of poorly managed pain in children with cancer and the unique pain management barriers this population faces in the era of an opioid crisis and global pandemic. First, data outlining the prevalence and characteristics of pain in children with cancer across the disease trajectory, and the state of the evidence for managing pain in this population, will be presented. Next, the role of family-level factors in the management of children’s cancer-related pain will be reviewed, including results on parents’ concerns regarding the use of pain medication for the treatment of their child’s cancer pain (over 60% agreed that pain medication was addictive and approximately 20% believed that children who take pain medication may learn to take drugs to solve other problems). Unique barriers to cancer pain management in the survivorship phase will be highlighted using data from a qualitative study of childhood cancer survivors (ages 8-18 years) and their parents. Areas for future work, including patient and family education and the need for high quality pain trials in this area will be discussed.Speaker 3: Lynn Gauthier, PhD, Université Laval, Department of Family and Emergency Medicine, Québec, QC, Canada, lynn.gauthier@crchudequebec.ulaval.ca, @docpeperSpeaker 3 Abstract Title: Managing cancer pain amidst the opioid crisis and the COVID-19 pandemic: The Canadian response to advancing the state of the evidence and safeguarding access to careSpeaker 3 Abstract: The opioid crisis is fuelling inadequate cancer pain management. Prior to the pandemic, media reports, editorials, and emerging US-data described reduced prescribing, opiophobia, stigma, and self-harm, prompting professional societies to warn policy makers against denying pain control. Unfortunately, empirical data documenting the extent and impact of the crisis in Canada are unavailable. This presentation will describe a CIHR-funded, cross-Canada knowledge dissemination and research planning initiative. Its aims were to elucidate the implications of the opioid crisis on cancer pain management in Canada and develop a future research agenda to investigate the impact of the crisis and identify ways to optimize pain management across the disease continuum and the lifespan amidst the crisis. A multidisciplinary team of 41 people with lived-experience, patient advocates, clinicians, and researchers with expertise in pain, oncology, palliative and supportive care, and addictions came together at two 2-day meetings in Vancouver and Montreal, in September, 2019. Topics included the clinical realities of managing cancer pain amidst the crisis, patient and caregiver lived experience, at-risk populations (children, older people, women), genetics, psychological comorbidities, substance misuse, cognitive impairment, other treatments (e.g. non-pharmacological treatments, cannabinoids), and systems and economic factors. Discussions highlighted major knowledge gaps, divergent perspectives on approaches to care, and substantial regional differences, including inconsistencies in reporting of harm outcomes, and systems and regulatory impacts. Results of a Delphi study identifying key research questions and recommendations to ensure access to adequate pain management during the pandemic for people with cancer at high risk of infection will be discussed.Learning Objective 1: To describe the problem of inadequate cancer pain management amidst the North American opioid crisis.Learning Objective 2: To understand the impact of the North American opioid crisis and COVID-19 pandemic on cancer pain management across the lifespan from various perspectives (e.g., providers, researchers, patients and caregivers).Learning Objective 3: To identify evidence-based strategies and national initiatives aimed at improving cancer pain management during the current North American opioid crisis.

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