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Safe Prescribing Practices: Clinicians' Views on Prescribing Opioids to Patients With Early-Stage Cancer

Purpose: Opioids are often necessary for patients experiencing high-intensity pain. However, side effects exist and some patients may misuse opioids. To better understand how opioids are prescribed to patients with early-stage cancer and how to enhance opioid safety, clinicians' views of opioid prescribing were explored.

Methods: This was a qualitative inquiry including any Alberta clinician prescribing opioids to patients with early-stage cancer. Semistructured interviews were conducted with nurse practitioners (NP), medical oncologists (MO), radiation oncologists (RO), surgeons (S), primary care physicians (PCP), and palliative care physicians (PC) between June 2021 and March 2022. Interpretive description was used to analyze the data using two coders. Debriefing sessions were used to resolve and discrepancies.

Results: Twenty-four clinicians were interviewed (NP [n = 5], MO [n = 4], RO [n = 4], S [n = 5], PCP [n = 3], and PC [n = 3]). The majority had been in practice at least 10 years. Prescribing practices were related to disciplinary perspective, goals of care, patient condition, and resource availability. Most clinicians did not see opioid misuse as a problem but were aware that specific patient risk factors are present and that long-term use can be problematic. Most clinicians undertake safe prescribing approaches tacitly (eg, screening for past opioid misuse and reviewing number of prescribers) and not all agreed they should be universally applied. Barriers (eg, procedural and time) and facilitators (eg, education) to safe prescribing approaches were identified.

Conclusion: To enhance uptake and cross-disciplinary consistency of safe prescribing approaches, clinician education regarding opioid misuse and benefits of safe prescribing practices, and addressing procedural barriers are necessary.

Wood T, Cheung W, Ruether D, Sinnarajah A, Tanguay R, Tarumi Y, Lau J, Cuthbert CA. Safe Prescribing Practices: Clinicians' Views on Prescribing Opioids to Patients With Early-Stage Cancer. JCO Oncol Pract. 2023 Jul;19(7):456-464. doi: 10.1200/OP.22.00766. Epub 2023 May 15. PMID: 37186890.


Peer Reviewed Journal Articles


  1. Harsanyi H, Yang L, Harper A, Jarada TN, Quan ML, Cheung WY, Lupichuk S, Cuthbert C, Xu Y. Improvement in patient-reported pain among patients with metastatic cancer and its association with opioid prescribing. Support Care Cancer. 2023 Jun 28;31(7):427. doi: 10.1007/s00520-023-07893-2. PMID: 37369812.

  2. Harsanyi H, Cuthbert C, Schulte F. The Stigma Surrounding Opioid Use as a Barrier to Cancer-Pain Management: An Overview of Experiences with Fear, Shame, and Poorly Controlled Pain in the Context of Advanced Cancer. Curr Oncol. 2023 Jun 17;30(6):5835-5848. doi: 10.3390/curroncol30060437. PMID: 37366920; PMCID: PMC10296997.

  3. Wood T, Cheung W, Ruether D, Sinnarajah A, Tanguay R, Tarumi Y, Lau J, Cuthbert CA. Safe Prescribing Practices: Clinicians' Views on Prescribing Opioids to Patients With Early-Stage Cancer. JCO Oncol Pract. 2023 Jul;19(7):456-464. doi: 10.1200/OP.22.00766. Epub 2023 May 15. PMID: 37186890.

  4. Cuthbert C, Twomey R, Bansal M, Rana B, Dhruva T, Livingston V, Daun JT, Culos-Reed SN. The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis. Support Care Cancer. 2023 Apr 11;31(5):254. doi: 10.1007/s00520-023-07716-4. PMID: 37039883; PMCID: PMC10088810.

  5. Cuthbert, CA, O'Sullivan DE, Boyne DJ, Brenner DR, Cheung WY. Patient-Reported Symptom Burden and Supportive Care Needs of Patients With Stage II-III Colorectal Cancer During and After Adjuvant Systemic Treatment: A Real-World Evidence Study. JCO Oncology Practice. 2023 Mar; 19(3): e377-e388. doi: 10.1200/OP.22.00462 

  6. Wagoner CW, Dreger J, Keats MR, Santa Mina D, McNeely ML, Cuthbert C, Capozzi LC, Francis GJ, Trinh L, Sibley D, Langley J, Chiekwe J, Ester M, Foucaut AM, Culos-Reed SN. First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources. International Journal of Environmental Research and Public Health. 2023 Jan 20;20(3): 1930. doi:10.3390/ijerph20031930

  7. Culos-Reed N, Wagoner CW, Dreger J, McNeely ML, Keats M, Santa Mina D, Cuthbert C, Capozzi LC, Francis GJ, Chen G, Ester M, McLaughlin E, Eisele M, Sibley D, Langley J, Chiekwe J, Christensen T; EXCEL Project Team. Implementing an Exercise Oncology Model to Reach Rural and Remote Individuals Living With and Beyond Cancer: A Hybrid Effectiveness-Implementation Protocol for Project EXCEL (EXercise for Cancer to Enhance Living Well). BMJ Open. 2022 Dec 29:12 (12): e063953. doi: 10.1136/bmjopen-2022-063953

  8. Urquhart R, Cordoba W, Bender J, Cuthbert C, Easley J, Howell D, Kaal J, Kendell C, Radford S, Sussman J. Risk Stratification and Cancer Follow-Up: Towards More Personalized Post-Treatment Care in Canada. Current Oncology. 2022 May 3;29(5): 3215-3223. doi:10.3390/curroncol29050261

  9. Grisbrook, MA, Dewey D., Cuthbert, C., McDonald S., Ntanda, H., Giesbrecht, G.F., Letourneau, N. Associations among Caesarean Section Birth, Post-Traumatic Stress, and Postpartum Depression. International Journal of Environmental Research and Public Health. 2022 Apr 18; 19(8): 4900. doi:10.3390/ijerph19084900

  10. Xu, Y., Cuthbert, C., Karim, S., Kong, S., Dort, J.C., Quan, M.L., Hinter, A.V., Quan, H., Hemmelgarn, B., & Cheung, B. (2022). Associations between physicians prescribing behaviors and persistent post-operative opioid use among cancer patients undergoing curative-intent surgery. Annals of Surgery. Feb 1;275(2):e473-e478. doi: 10.1097/SLA.0000000000003938.

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  12. Lin N, Dabas E, Quan ML, Cheung WY, Cuthbert C, Feng Y, Kong S, Sauro K, Brenner D, Yang L, Xu Y. (2021). Outcomes and healthcare utilization among new persistent opioid users and non-opioid users after curative intent surgery for cancer. Annals of Surgery. doi:10.1097/SLA.0000000000005109

  13. Cuthbert C, Farragher JF, Farrer CL, Cheung WY. (2021). Living with paradox: A qualitative study of colorectal cancer patients and their caregivers’ experiences in managing health after cancer treatment. European Journal of Cancer Care, May 30(3), e13416. doi:10.1111/ecc.13416

  14. Batra, A, Yang, L., Boyne, D.J., Harper, A., Cuthbert, C., Cheung, W. (2020).  Symptom burden in patients with common cancers near end-of-life and its associations with clinical characteristics: A real world study. Support Care Cancer Jun;29(6):3299-3309. doi: 10.1007/s00520-020-05827-w. Epub 2020 Oct 26.

  15. Batra A, Yan L, Boyne D, Harper A, Cuthbert C, Cheung W. (2020). Association between baseline symptom burden as assessed by patient-reported outcomes and overall survival of patients with metastatic cancer. Supportive Care Cancer. Mar;29(3):1423-1431. doi: 10.1007/s00520-020-05623-6. Epub 2020 Jul 16.

  16. Singh N, Batra A, Yang L, Boyne D, Harper A, Ghatage P, Cuthbert C, Cheung W. (2020). Patient-reported outcomes near end-of-life in patients with gynaecological cancers. Journal of Obstetrics and Gynecology of Canada. Published July 2, 2020. Doi:10.1016/jogc.2020.06.017

  17.  Cuthbert, C., Boyne, D., Hemmelgarn, B., Cheung, W. (2020). Patient reported symptom burden and supportive care needs at cancer diagnosis: A retrospective cohort study. Supportive Cancer Cancer. Dec;28(12):5889-5899. doi: 10.1007/s00520-020-05415-y. Epub 2020 Apr 8.

  18. Cuthbert, C., Xu, Y, Kong, S., Boyne, D., Hemmelgarn, B., Cheung, W. (2020). Patient level factors associated with chronic opioid use in cancer: A population-based cohort study. Supportive Care Cancer, Sep;28(9):4201-4209. doi: 10.1007/s00520-019-05224-y. Epub 2020 Jan 3.  

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  20. Cuthbert, C.A, Farragher, J.F., Hemmelgarn, B.R., Qirui, D., McKinnon, G.P., Cheung, W. (2019). Self-management interventions for cancer survivors: A systematic review and evaluation of intervention content and theories. Psycho-Oncology. doi: 10.1002/pon.5215

  21. Boyne, D.J., Cuthbert, C.A., O’Sullivan, D.E., Sajobi, T.T., Hilsden, R.J., Friedenreich, C.E., Cheung, W.Y., Brenner, D.R. (2019). Adjuvant chemotherapy duration and survival among stage II and III colon cancer patients: A systematic review and meta-analysis. JAMA Netw Open, May 3;2(5):e194154 doi:10.1001/jamanetworkopen.2019.4154

  22. Cuthbert, C., Hemmelgarn, B.R., Yuan, X., Cheung, W. (2018) The effect of comorbidities on outcomes in colorectal cancer: a population based cohort study. Journal of Cancer Survivorship, 12, 733-743. doi: 10.1007/x11764-018-0719

  23. Cuthbert, C., Samawi, H., Hemmelgarn, B., Cheung, W. (2018). Effectiveness and Components of self-management interventions in adult cancer survivors: a protocol for a systematic review and planned meta-analysis. Systematic Reviews, 7,238. doi: 10.1186/s13643-018-0902-7

  24. Cuthbert, C., King-Shier, K., Ruether, D., Tapp, D., Wytsma-Fisher, W., Fung, T., & Culos-Reed, S.N. (2018). The effects of exercise on physical and psychological outcomes in cancer caregivers: Results from the RECHARGE randomized controlled trial. Annals of Behavioral Medicine, 52, 645-661. doi: 10.1093/abm/kax040.

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  26. Cuthbert, C., King-Shier, K., Tapp, D., Ruether, D., & Culos-Reed, S.N. (2017) Exploring gender differences in self-reported physical activity levels and health among older caregivers. Oncology Nursing Forum, 44(4), 435-445. doi:10.1188/17.ONF.435-445

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Letters to the Editor

1. Farrer, C., Daze, E., Born, K., Cuthbert, C. (2021). Adapting to a virtual format during COVID-19. CMAJ blogpost.


2. Cuthbert, C. (2019). Response to letter to the editor. Psycho-Oncology. doi:10.1002/pon.5319

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