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Comprehensive Relief from Cancer Pain Expanding the Conversation on Opioid-Induced Constipation

Lorraine Drapek, DNP, FNP-BC, AOCNP; Mihir Kamdar, MD; April Hazard Vallerand, PhD, RN, FAAN

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

 

This activity is supported by an educational grant from AstraZeneca.

 

Target Audience

The educational design of this activity addresses the needs physician assistants (PAs), nurse practitioners (NPs), and other oncology nurses involved in the management of patients with opioid-treated cancer pain.

Statement of Need/Program Overview

Despite a growing number of specific treatment options, many patients with cancer pain still suffer from opioid-induced constipation (OIC).1-3 Open communication among patients, caregivers, and treating clinicians is essential to determine the severity and psychosocial consequences of OIC.1-4 Patients with cancer pain and their proxies, however, are often reluctant to discuss opioid-related gastrointestinal symptoms and effects on quality of life. To address this barrier, clinicians should provide upfront education on the signs and symptoms of OIC, monitor bowel patterns at baseline and each subsequent visit, and use validated assessment tools to document changes in bowel habits.5,6 Monitoring can inform clinical decisions about escalating OIC treatment, including the introduction of mechanism-based therapies into bowl regimens.5,7 Shared clinical decision making that addresses patient preferences for OIC management (eg, oral vs subcutaneous administration of medication) is also critical.8,9 A patient-centric approach has been shown to improve clinical outcomes, satisfaction with care, and adherence to the ongoing treatment plan.10 This Through the Patient’s Eyes™ Webcast has been designed to educate oncology NPs, PAs, nurses, and other healthcare providers on proactively dialoging with oncology patients about OIC risks, longitudinally monitoring these individuals for opioid-related gastrointestinal issues, and properly advocating for bowel regimens that reduce the burdens of OIC.

References

  1. Whitman CB, et al. Balancing opioid-induced gastrointestinal side effects with pain management: Insights from the online community. J Opioid Manag. 2015;11(5):383-391.
  2. Panchal SJ, et al. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. 2007;61(7):1181-1187.
  3. Villars P. et al. Differences in the prevalence and severity of side effects based on type of analgesic prescription in patients with chronic cancer pain. J Pain Symptom Manage. 2007;33(1):67-77.
  4. Bell TJ, et al. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med. 2009;10(1);35-42.
  5. Argoff CE, et al. Consensus recommendations on initiating prescription therapies for opioid-induced constipation. Pain Med. 2015;16(12):2324-2337.
  6. Rentz AM, et al. Validation of the Bowel Function Index to detect clinically meaningful changes in opioid-induced constipation. J Med Econ. 2009;12(4):371-283.
  7. Streicher JM, Bilsky EJ. Peripherally acting µ-opioid receptor antagonists for the treatment of opioid-related side effects: Mechanism of action and clinical implications. J Pharm Pract. 2017 Jan 1. [Epub ahead of print].
  8. Lee J, et al. What are the patient factors affecting repetitive use of injectable pain relievers in outpatient care settings? Int J Clin Pharmacol Ther. 2014;52(3):202-208.
  9. Anantharamu T, et al. Naloxegol: First oral peripherally acting mu opioid receptor antagonists for opioid-induced constipation. J Pharmacol Pharmacother. 2015;6(3):188-192.
  10. Joosten EA, et al. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77(4):219-226.

Educational Objectives

Upon completion of this activity, participants will be able to:

  1. Evaluate baseline bowel patterns subsequent changes over time patients with cancer who require opioid-based pain management
  2. Compare the mechanisms of action, FDA indications, published evidence, and prescribing considerations for mechanism-based treatment options for OIC associated with cancer pain
  3. Recommend a newer mechanism-based treatment option to patients with cancer pain who have not responded to traditional laxative therapy
  4. Engage with patients with opioid-treated cancer pain to better understand their current analgesic regimen, assess bowel function, and participate in shared decision-making about therapy for OIC

Faculty

Lorraine Drapek, DNP, FNP-BC, AOCNP
Clinical and Research Nurse Practitioner
Gastrointestinal Radiation Oncology Service
Massachusetts General Hospital
Boston, Massachusetts

Mihir Kamdar, MD
Associate Director, Division of Palliative Care
Director, MGH Cancer Pain Clinic
Massachusetts General Hospital
Boston, Massachusetts

April Hazard Vallerand, PhD, RN, FAAN
Associate Dean for Research
Director of the Office for Health Research
Director of the PhD Program
College of Nursing Alumni Endowed Professor
Wayne State University
Detroit, Michigan

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 webcast for a maximum of 1.0 AMA PRA Category 1 Credit™.  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 hours is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hours of Category 1 credit for completing this program.

Global Contact Information

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

Instructions to Receive Credit

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

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:

Lorraine Drapek, DNP, FNP-BC:  Nothing to disclose
Mihir Kamdar, MD:  Nothing to disclose
April Vallerand, PhD, RN, FAAN:  Nothing to disclose

The 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:

Lindsay Borvansky, Gena Dolson, Andrea Funk, Ashley Marostica, RN, MSN, Jim Kappler, PhD, Liddy Knight, Rose O’Connor, PhD, CHCP, hereby state that neither they nor their spouses/life partners have any financial relationships to products or devices with any commercial interest related to the content of these activities of any amount during the past 12 months.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. 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 recommendations of other authorities.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

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credit amount 1.00

credit type CE

release 10/16/2018

expiration 10/25/2019