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Overcoming Challenges in Cancer Pain Management Engaging With Patients About Opioid-Induced Constipation

Anthony J. Lembo, MD; Nicole M. Ross, MSN, CRNP, AOCNP; Michael J. Brennan, MD; Mihir M. Kamdar, MD; Patricia A. Jakel, RN, MN, AOCN

 

This activity is jointly provided by Global Education Group and Integritas Communications.


This activity is supported by an educational grant from AstraZeneca

Faculty

Anthony J. Lembo, MD
Associate Professor of Medicine
Harvard Medical School
Director, GI Motility Laboratory
Division of Gastroenterology
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Nicole M. Ross, MSN, CRNP, AOCNP
Advanced Practice Clinician
Advanced Oncology Certified Nurse Practitioner
Department of Hematology/Oncology
Fox Chase Cancer Center
Philadelphia, Pennsylvania

Michael J. Brennan, MD
Medical Director
The Pain Center of Fairfield
Fairfield, Connecticut
Associate Director
Chronic Pain and Recovery Center
Silver Hill Hospital
New Canaan, Connecticut
Senior Attending Physician
Department of Medicine
Bridgeport Hospital
Bridgeport, Connecticut

Mihir M. Kamdar, MD
Associate Director
Division of Palliative Care & and Geriatric Medicine
Department of Medicine
Director, Cancer Pain Clinic
Attending, Palliative Care and Anesthesia Pain Medicine
Massachusetts General Hospital
Instructor in Medicine
Harvard Medical School
Boston, Massachusetts

Pattie A. Jakel, RN, MN, AOCN
Advanced Practice Nurse
Advanced Oncology Certified Nurse
Solid Tumor Program
University of California, Los Angeles Medical Center
Santa Monica, California

Target Audience

The educational design of this activity addresses the needs of oncology nurses and other clinicians involved in assessing and managing patients with cancer and opioid-induced constipation (OIC).

Statement of Need/Program Overview

As many as one in three patients with cancer suffers from clinically significant pain.1-3 Owing to a broad analgesic spectrum and marked dosing flexibility, opioids have long been the cornerstone of cancer pain therapy.4 Yet the side effects of prescription opioids can limit potential clinical benefits. This is especially true of the most common opioid-related adverse event, constipation, which can be more detrimental to patient function and quality of life than the underlying cancer-related pain.5-8 During this Engaging the Patient™ program, a multidisciplinary faculty panel will review the pathophysiology of OIC, bowel assessment strategies to help monitor opioid-treated oncology patients, prophylactic laxative treatment regimens, and newer agents that have been approved by the US Food and Drug Administration (FDA) as effective and safe therapies for OIC. Prerecorded patient testimonials and examples of patient-clinician interactions will help shape the interactive faculty discussions. Attendees are sure to complete this educational session with new information and a fresh perspective on managing patients with OIC.

References

  1. Cohen MZ, et al. J Pain Symptom Manage. 2003;25(6):519-527.
  2. Goudas LC, et al. Cancer Invest. 2005;23(2):182-190.
  3. Dahl JL. J Natl Cancer Inst Monogr. 2004;32:124-126.
  4. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 2.2016.
  5. Coyne KS, et al. Clinicoecon Outcomes Res. 2014;6:269-281.
  6. Gatti A, Sabato AF. Clin Drug Investig. 2012;32(5):293-301.
  7. Holzer P. Expert Opin Investig Drugs. 2007;16(2):181-194.
  8. Rao SS. Gastroenterol Clin North Am. 2007;36(3):687-711.

Educational Objectives

After completing this activity, the participant will be better able to:

  • Evaluate baseline and ongoing bowel function in patients with cancer who require opioid-based pain management
  • Describe the mechanisms of action, published evidence, and practical considerations related to new treatment options for OIC
  • Recommend prophylactic bowel regimens and newer OIC treatment options when opioid-based treatment regimens are used to treat cancer pain
  • Communicate with opioid-treated patients with cancer pain to facilitate bowel assessment efforts and shared decision-making about OIC treatment options

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education

Global Education Group is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This educational activity for 1.0 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse Practitioners (AANP) through joint providership of Global Education Group and Integritas Communications. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 1561024. This activity is approved for 1.0 contact hour which includes 0.0 hour of pharmacology. Activity ID #2417E.

This activity was planned in accordance with AANP CE Standards and Policies.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 70% or better on the posttest and complete the program evaluation

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: 

Anthony J. Lembo, MD Consultant/Independent Contractor:  Alkermes plc, Ardelyx, Inc., Forest Laboratories, Inc., Ironwood Pharmaceuticals, Inc., Prometheus Laboratories Inc., Salix Pharmaceuticals, Inc.; Grant/Research Support: Prometheus Laboratories Inc.

Nicole M. Ross, MSN, CRNP, AOCNP Honoraria: Eli Lilly and Company, Medscape, Taiho Oncology, Inc.

Michael J. Brennan, MD Consultant/Independent Contractor: AstraZeneca, Cara Therapeutics Inc., Collegium Pharmaceutical Inc., Depomed, Inc., Progenics Pharmaceuticals, Inc., Purdue Pharma L.P., Teva Pharmaceuticals USA Inc.; Honoraria: AstraZeneca, Collegium Pharmaceutical Inc., Depomed, Inc., Progenics Pharmaceuticals, Inc., Purdue Pharma L.P., Teva Pharmaceuticals USA Inc.; Stockholder: Cara Therapeutics Inc.

Mihir M. Kamdar, MD Consultant/Independent Contractor: Collegium Pharmaceutical Inc.

Patricia A. Jakel, RN, MN, AOCN Speakers Bureau: Genentech, Inc., Merck & Co., Inc.

The following planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Ashley Marostica, RN, MSN  Nothing to disclose
Kristin Delisi, NP Nothing to disclose
Lindsay Borvansky Nothing to disclose
Andrea Funk  Nothing to disclose
Jim Kappler, PhD  Nothing to disclose
Rose O'Connor, PhD  Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommend

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credit amount 1.00

credit type CME/CE

release 08/31/2017

expiration 08/31/2018

type Webcast