TY - JOUR
T1 - The development of a nomogram to determine the frequency of elevated risk for non-medical opioid use in cancer patients
AU - Yennurajalingam, Sriram
AU - Edwards, Tonya
AU - Arthur, Joseph
AU - Lu, Zhanni
AU - Erdogan, Elif
AU - Malik, Jimi S.
AU - Naqvi, Syed Mujtaba Ali
AU - Wu, Jimin
AU - Liu, Diane D.
AU - Williams, Janet L.
AU - Hui, David
AU - Reddy, Suresh K.
AU - Bruera, Eduardo
N1 - Publisher Copyright:
Copyright © The Author(s), 2020. Published by Cambridge University Press.
PY - 2021/2
Y1 - 2021/2
N2 - Objective 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. Method 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. Results 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. Significance of results 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.
AB - Objective 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. Method 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. Results 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. Significance of results 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.
KW - Alcoholism
KW - cancer pain
KW - drug abuse
KW - nomogram
KW - non-medical opioid use
KW - opioids
KW - risk of aberrant opioid behavior
KW - smoking
KW - symptoms
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U2 - 10.1017/S1478951520000322
DO - 10.1017/S1478951520000322
M3 - Review article
C2 - 32729447
AN - SCOPUS:85090861849
SN - 1478-9515
VL - 19
SP - 93
EP - 102
JO - Palliative and Supportive Care
JF - Palliative and Supportive Care
IS - 1
ER -