The development of a nomogram to determine the frequency of elevated risk for non-medical opioid use in cancer patients

• Published in: Palliative & supportive care Vol. 19; no. 1; pp. 3 - 10
• Main Authors: Yennurajalingam, Sriram, Edwards, Tonya, Arthur, Joseph, Lu, Zhanni, Erdogan, Elif, Malik, Jimi S., Naqvi, Syed Mujtaba Ali, Wu, Jimin, Liu, Diane D., Williams, Janet L., Hui, David, Reddy, Suresh K., Bruera, Eduardo
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.02.2021
• Subjects: Alcoholism; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anxiety; Cancer; Cancer Pain - drug therapy; Confidence intervals; Gender; Humans; Male; Morphine; Narcotics; Neoplasms - drug therapy; Nomograms; Opioid-Related Disorders - etiology; Original Article; Pain; Pain management; Pain Management - adverse effects; Pain Management - methods; Palliative care; Patients; Performance evaluation; Risk Assessment; United States > US; cancer pain; symptoms; non-medical opioid use; drug abuse; Alcoholism; smoking; nomogram; risk of aberrant opioid behavior; opioids
• ISSN: 1478-9515; 1478-9523; 1478-9523
• DOI: 10.1017/S1478951520000322

Non-medical opioid use (NMOU) is a growing crisis. Cancer patients at elevated risk of NMOU (+risk) are frequently underdiagnosed. The aim of this paper was to develop a nomogram to predict the probability of +risk among cancer patients receiving outpatient supportive care consultation at a comprehensive cancer center. 3,588 consecutive patients referred to a supportive care clinic were reviewed. All patients had a diagnosis of cancer and were on opioids for pain. All patients were assessed using the Edmonton Symptom Assessment Scale (ESAS), Screener and Opioid Assessment for Patients with Pain (SOAPP-14), and CAGE-AID (Cut Down-Annoyed-Guilty-Eye Opener) questionnaires. "+risk" was defined as an SOAPP-14 score of ≥7. A nomogram was devised based on the risk factors determined by the multivariate logistic regression model to estimate the probability of +risk. 731/3,588 consults were +risk. +risk was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD (morphine equivalent daily dose), and CAGE-AID score. The C-index was 0.8. A nomogram was developed and can be accessed at https://is.gd/soappnomogram. For example, for a male Hispanic patient, married, never smoked, with ESAS scores for depression = 3, anxiety = 3, financial distress = 7, a CAGE score of 0, and an MEDD score of 20, the total score is 9 + 9+0 + 0+6 + 10 + 23 + 0+1 = 58. A nomogram score of 58 indicates the probability of +risk of 0.1. We established a practical nomogram to assess the +risk. The application of a nomogram based on routinely collected clinical data can help clinicians establish patients with +risk and positively impact care planning.