Opioids in advanced lung malignancy: A clinical audit of opioid prescription, patient education and safeguarding.

Abstract

BACKGROUND\nOpioids have an important role in symptom management for people with advanced cancer. Clinical guidelines recommend patient education to ensure the safe use of opioids, however, no Australian studies have explored current education and safeguarding practices when opioids are initiated to advanced cancer patients.\n\n\nAIMS\nTo investigate risk assessment, safeguarding and education practices when opioids are first prescribed to advanced lung cancer patients METHODS: A retrospective medical record audit of outpatients with advanced non-small cell lung cancer seen at a tertiary Australian hospital between 1/1/2015 - 31/12/2019 and prescribed strong opioids for cancer-related symptoms.\n\n\nRESULTS\nOf 1022 patients attending the lung cancer clinic, 205 were newly initiated on an opioid. Opioid-related risks including previous recreational drug use (28, 13.6%) and history of falls (16, 7.9%) were infrequently documented. Opioid-related safeguards and adverse effects management were variably instituted: written GP correspondence at opioid initiation (62, 30%), clinic follow-up (186, 91%) and laxative co-prescription (55, 26.8%). Most patients (137, 66.8%) received no documented opioid education on drug initiation. There was no association between age (P=0.653), number of comorbidities (P=0.569) or chronic alcohol use (P=0.263) and the provision of education on opioid initiation. Palliative care doctors or nurse practitioners were eight times more likely to document opioid education than medical oncologists (OR=\u20098.5, CI=\u20092.9-24.8, P<0.0001).\n\n\nCONCLUSION\nGuideline-recommended risk assessment, safeguards, and patient education were infrequently documented when opioids were initiated. Clinician training, decision assist prompts in electronic prescribing software and written education resources for patients may address these gaps in care. This article is protected by copyright. All rights reserved.