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

Published online by Cambridge University Press:  30 July 2020

Sriram Yennurajalingam Open the ORCID record for Sriram Yennurajalingam [Opens in a new window] ,
Tonya Edwards ,
Joseph Arthur ,
Zhanni Lu ,
Elif Erdogan ,
Jimi S. Malik ,
Syed Mujtaba Ali Naqvi ,
Jimin Wu ,
Diane D. Liu  and
Janet L. Williams
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Sriram Yennurajalingam*
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Tonya Edwards
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Joseph Arthur
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Zhanni Lu
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Elif Erdogan
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Jimi S. Malik
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Syed Mujtaba Ali Naqvi
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Jimin Wu
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
Diane D. Liu
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
Janet L. Williams
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
David Hui
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Suresh K. Reddy
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Eduardo Bruera
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
*
Author for correspondence: Sriram Yennurajalingam, Department of Palliative Care, Rehabilitation, and Integrative Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. E-mail: syennu@mdanderson.org
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Abstract

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.

Keywords

Alcoholismcancer paindrug abusenomogramnon-medical opioid useopioidsrisk of aberrant opioid behaviorsmokingsymptoms
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 1 , February 2021 , pp. 3 - 10
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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