Feasibility and Acceptability of an Overdose Prevention Intervention Delivered by Community Pharmacists for Patients Prescribed Opioids for Chronic Non-Cancer Pain.

There have been increases in prescriptions of high strength opioids for chronic non-cancer pain (CNCP), but CNCP patients perceive themselves as being at low risk of opioid overdose and generally have limited overdose awareness. This study examined how an overdose prevention intervention (opioid safety education, naloxone training, and take-home naloxone (THN)) delivered by community pharmacists for patients prescribed high-strength opioids for CNCP would work in practice in Scotland. Twelve patients received the intervention. CNCP patients and Community Pharmacists were interviewed about their experiences of the intervention and perceptions of its acceptability and feasibility. CNCP patients did not initially perceive themselves as being at risk of overdose but, through the intervention, developed insight into opioid-related risk and the value of naloxone. Pharmacists also identified patients' low risk perceptions and low overdose awareness. While pharmacists had positive attitudes towards the intervention, they outlined challenges in delivering it under time and resource pressures and during the COVID-19 pandemic. Overdose prevention interventions are required in the CNCP population as this group has elevated risk factors for overdose but are commonly overlooked. Customised overdose prevention interventions for CNCP patients attend to gaps in overdose awareness and risk perceptions in this population.

Palliative management of a patient with gastric outlet obstruction (GOO) due to caput pancreatic cancer during COVID-19 pandemic

Background: Pancreatic cancer is associated with a poor prognosis and high cancer-related deaths in developed and developing countries because most of the patients are symptomatic until the advanced stage. A small percentage of pancreatic cancer could develop gastric outlet obstruction (GOO) when the tumor causes intestinal obstruction. This case report aimed to highlight the palliative management of GOO due to caput pancreatic cancer. Case presentation: A 48 years-old male was admitted to Dr Soetomo General Academic Hospital in Surabaya during coronavirus disease 2019 (COVID-19) pandemic with complaint of severe heartburn and pain for the last two months with lump around the upper right abdomen. The pain was not related to diet and only slightly relieved by pain relievers and ulcer medication. The patient also complained of nausea and vomiting after eating and drinking with significant weight loss. Unclear borders mass was palpable. The magnetic resonance imaging (MRI) of upper abdomen yielded the mass of head pancreatic that invaded the duodenum, the involvement of the superior mesenteric artery and multiple lymphadenopathies in the paraaortic. Pathology examination confirming the malignant, ductal adenocarcinoma. With other examinations, the patient was diagnosed as GOO due to T4N1M0 head pancreatic cancer. The tumor was unresectable. The patient underwent urgent double bypass biliodigestive laparotomy as part of palliative management. loop gastrojejunostomy, cholecystectomy and choledocujejunostomy Roux en Y was performed. Celiac plexus block was performed to reduce the cancer pain in the patient. Conclusion: This case highlights that the GOO case's selected management depends on the stage disease and evaluation of multidisciplinary involvement even in the COVID-19 pandemic. Therefore, collaboration between surgeons, medical oncologists, gastroentero-hepatologist, radiologists, and supportive and palliative care specialists is required to reduce mortality. © 2023, Sanglah General Hospital. All rights reserved.

IMPLEMENTING THE NYU ELECTRONIC PATIENT VISIT ASSESSMENT (EPVA) TO IMPROVE PATIENT OUTCOMES IN HEAD AND NECK CANCER

Patients with head and neck cancer (HNC) experience severe symptoms and associated functional limitations during the cancer treatment. The NYU Electronic Patient Visit Assessment (ePVA) was developed for early detection and interventions for uncontrolled symptoms in HNC. This randomized, non-blinded, phase 0/I study assessed the feasibility of conducting a large randomized clinical trial to evaluate the efficacy of the ePVA to improve pain management and Health-Related Quality of Life in patients with HNC. Methods: The study was conducted at an NCI -Designated Comprehensive Cancer Center in the Northeastern United States. 32 Participants were randomized to: 1) ePVA intervention or 2) usual care. The intervention consisted of participants completing the ePVA every other week during radiation therapy (RT), then weeks 4, 12, and 24 after end of RT. Automated reports of ePVA data, including pain reports and patient-reports of pain medications, were sent to providers to inform their clinical decisions. Because of COVID-19, the study team converted all study procedures to remote telehealth. Potential participants were contacted 5 to 7 days before starting radiation therapy, and informed consent was obtained using REDCap e-consent. The study team met accrual goals by enrolling 32 participants, with a recruitment rate of 68%. The primary reason that potential participants did not enroll in the study was their feeling overwhelmed with the diagnosis and start of treatment. Participants' mean age was 60, and the study population was primarily male (69%), white (81%), and non-Hispanic (81%). The two study groups' gender, race, cancer stage, and treatment were balanced across study arms. 88% (28 of 32) of participants completed 6 of 7 planned data time points, meeting feasibility criteria for a large multi-site randomized clinical trial. On average, the ePVA arm had non-significant trends toward less pain and mildly better HRQoL than patients with usual care. These findings indicate the feasibility of conducting a large randomized clinical trial of a digital remote monitoring system. Other findings include encouraging but non-significant trends toward better pain control and HRQoL in this small sample size, but generalizations of this study data are limited because of the small sample size.

Quality of care in the course of subcutaneous versus intravenous trastuzumab administration in patients with breast cancer: an integrated time-motion study with mixed-methods research.

OBJECTIVES: This study aimed to compare the time required and concerns raised by various perspectives of participants regarding administering subcutaneous and intravenous trastuzumab for patients with breast cancer (BC). DESIGN: This observational time-motion study design with mixed-methods research (cross-sectional surveys and semistructured interviews) was conducted. The time spent on preparing or administering trastuzumab by different healthcare professionals (HCPs) was recorded. The data were analysed by descriptive/inferential statistical analyses, followed by thematic analyses. SETTING: Outpatient and inpatient administration units of a single medical centre in Taiwan. PARTICIPANTS: The study included patients with early-stage BC who received subcutaneous or intravenous trastuzumab (n=93), and HCPs including two attending physicians, a nurse practitioner, two pharmacists and two nurses. RESULT: Based on the perspectives of patients and HCPs, the subcutaneous form of trastuzumab was more efficient, less expensive and produced less discomfort in outpatient units than inpatient units. More participants preferred the subcutaneous form over the intravenous form in both outpatient and inpatient units. Pharmacists and nurse practitioners spent threefold more time on patients when preparing and administering the intravenous form in both outpatient and inpatient units. The concerns raised by patients and HCPs varied in certain aspects, including the injection skills, speed, mental distress (eg, needle phobia) and pain associated with the subcutaneous form. Almost all patients preferred receiving the subcutaneous form in outpatient units after the initial COVID-19 outbreak. CONCLUSION: Patients with early-stage BC preferred receiving subcutaneous trastuzumab in outpatient units rather than inpatient units or the intravenous form before and after the COVID-19 outbreak. Such findings may serve as real-world evidence to facilitate better quality of care regarding administration of subcutaneous or intravenous trastuzumab in medical settings, and its feasible resolutions to balance the quality, concerns and efficiency of anticancer administration during the COVID-19 pandemic.

Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care.

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems. METHODS: We interviewed patients with chronic non-cancer pain and history of substance use (n = 22) and their primary care clinicians (n = 7) in the San Francisco Bay Area, March-July 2020. We recorded, transcribed, coded, and content analyzed interviews. RESULTS: COVID-19 shelter-in-place orders contributed to increases in substance use and uncontrolled pain, and posed challenges for monitoring opioid safety and misuse through telehealth. None of the clinics used video visits due to low digital literacy/access. Benefits of telehealth included decreased patient burden and missed appointments and increased convenience and control of some chronic conditions (e.g., diabetes, hypertension). Telehealth challenges included loss of contact, greater miscommunication, and less comprehensive care interactions. CONCLUSIONS: This study is one of the first to examine telehealth use in urban safety net primary care patients with co-occurring chronic non-cancer pain and substance use. Decisions to continue or expand telehealth should consider patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity.

Implementation of a Hybrid Care Model for Telemedicine-based Cancer Pain Management at the Cancer Center of Naples, Italy: A Cohort Study.

BACKGROUND/AIM: Telemedicine, the remote delivery of healthcare services, represents a great opportunity for cancer pain management. A care model of telemedicine that combines remote visits and hospital access could be an effective and safe strategy for pain management of cancer patients. PATIENTS AND METHODS: A retrospective study was conducted using the dataset of the telemedicine program at the Istituto Nazionale Tumori of Naples, Italy for assessing the efficacy of a telehealth-based model of care. Demographic, clinical, and process variables were investigated. RESULTS: A total of 226 cases and 489 visits were included in the analysis. The mean age of patients was 63.4 years (SD=12.4 years), and no sex differences were observed. Approximately 55% of patients were ECOG-PS ≤2 and 87% suffered from metastatic disease. More than half of the patients were treated with high doses of opioids. Each patient had a mean of 2 remote visits and half of the patients had more than 1 telehealth consultation. The dropout ratio was 5.3%. Most visits (n=472) were conducted on patients in the Campania Region, Italy. The maximum covered distance from the Cancer Center and the patients' location was 555.22 Km. A significant difference in the overall number of visits (p=0.006) and the number of pro-capita remote visits (p=0.010) was found, in favor of the group of patients treated before the end of the Covid-19 emergency in Italy, compared to those treated after the pandemic. CONCLUSION: Despite various positive outcomes, the analysis highlights several weaknesses, such as the need to assist patients with advanced and non-advanced disease located outside the regional territory. Overall, the telehealth processes should be adapted to post-pandemic scenarios towards their implementation in routine clinical practice.

Systematic review of spontaneous reports of myocarditis and pericarditis in transplant recipients and immunocompromised patients following COVID-19 mRNA vaccination.

OBJECTIVES: To determine whether spontaneous reporting rates of myocarditis and pericarditis differed in immunocompromised patients compared with the whole population overall, and in terms of demographics, vaccine dose and time-to-onset. DESIGN: Systematic review of spontaneously reported data from the European Union/European Economic Area (EU/EEA), the USA and the UK. DATA SOURCES: EudraVigilance (EU/EEA), Vaccine Adverse Event Reporting System (VAERS; USA) and the Medicines and Healthcare products Regulatory Agency (UK) spontaneous reporting databases were searched from date of vaccine launch to 1 December 2021. ELIGIBILITY CRITERIA: Publicly available spontaneous reporting data for 'myocarditis' and 'pericarditis' from EU/EEA and USA following COVID-19 messenger RNA vaccines. Reports with comorbidities or concurrent medication indicative of transplantation, HIV infection or cancer ('immunocompromised' population) were compared with each overall database population. DATA EXTRACTION AND SYNTHESIS: Two researchers extracted data. Spontaneously reported events of myocarditis and pericarditis were presented for immunocompromised populations for each data source, stratified by age, sex, dose and time-to-onset (where available). Seriousness of each event was determined according to the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guideline E2A definition. Proportional reporting ratio (PRR) was calculated. RESULTS: There were 178 reports of myocarditis and pericarditis among immunocompromised individuals overall. Seriousness was comparable between the immunocompromised and overall populations in both databases. No trends in age or sex were observed among immunocompromised individuals. Most reports followed a second vaccine dose and occurred within 14 days. The frequency of reporting was similar to the wider population (PRR=1.36 (95% CI=0.89 to 1.82) for VAERS population). CONCLUSIONS: Myocarditis and pericarditis following COVID-19 vaccination are very rare, and benefits of COVID-19 vaccination continue to outweigh any perceived risks. Reporting rates of myocarditis and pericarditis were similar in immunocompromised individuals, however defining characteristics differed compared with the whole population; therefore, continued monitoring of adverse events following vaccination remains vital to understand differences between population subgroups.

1st Croatian Virtual Congress of Oncology Pharmacy

The proceedings contain 46 papers. The topics discussed include: clinical features and differential diagnosis of the most common malignant tumors of the skin;medication errors in the treatment of pain in cancer patients;hospital pharmacy in 21st century;the NCODA positive quality intervention (PQI): educating your medically integrated team while supporting better patient care with a concise, peer-reviewed, pharmacy-led resource;challenges and possibilities in the prevention and treatment of febrile neutropenia in oncology patients during the COVID-19 pandemic;cancer pain management;oral anticancer medication;and aseptic manufacture (compounding)/preparation of antineoplastic drugs - requirements, standards and guidelines.

IMJM Volume 21 No.3, July 2022 25 REVIEW ARTICLE Cognitive Behavioural Therapy for Chronic Pain Management: A Narrative Review

Chronic pain is disabling and impacts an individual’s psychosocial and functioning in multiple areas. Cognitive Behavioural Therapy (CBT) appears to be one of the psychotherapies that has good potential of prominent efficacy in managing chronic pain. This narrative review aims to provide the necessary information and latest development on the delivery, results efficacy and barriers of CBT in chronic pain management. A search was conducted at Pubmed and Web of Science in April 2021 yielding a total of 251 articles. After careful screening and filtration, a total of 21 articles was selected for this review. Of these 21 articles, CBT was observed to be commonly delivered through online, which helped to preserving cost, promoting adherence, having good efficacy and also safer during the time of the Covid-19 pandemic. Most of the articles showed significant efficacy of CBT in chronic pain management. In order to improve CBT for better efficacy, understanding and consideration towards mediators that affect pain outcome and barriers in implementation are crucial in developing modules in CBT for chronic pain management. As such, CBT can be improved by integrating customised components in the modules to target mediators specifically, and training can be provided for psychotherapist to combat the barrier of online communication and time management. For future research, direction can be focused on development of CBT modules that are specific to chronic pain management. [ FROM AUTHOR] Copyright of IIUM Medical Journal Malaysia is the property of International Islamic University Malaysia, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Palliative Radiation Therapy for Painful Bone Metastasis in Times of COVID-19

Background/aims: Radiation therapy is critical for the treatment of painful bone metastases, providing an improvement in the quality of life of cancer patient. During the coronavirus disease 2019 (COVID-19) pandemic period, radiation oncologists have adapted to the situation, modifying the fractionations to shorter schedules, to prevent the risk of infection in palliative patient. Methods: Patients who receive antialgic palliative radiotherapy for painful bone metastases from March 2020 to March 2021 were reviewed. In this review we analyze the evolution of treatment schedules in related to the pandemic, as well as other data of interest related to the treatment. Results: 178patients were analyzed, with an average age of 68years (36-93years). 67.42% patients were males and 32.58% females. Most frequently primary tumors were 38%lung, 21%prostate and 18%breast. Pain bone metastasis were diagnosed as a debut symptom in 19 patients (10.67%). 7 patients(3.93%) required reirradiation. 110 patients(68%) died. Treatment schedules were: 99 patients (55.62%) received 5 fractions of 4Gy, 43 (24.16%) single fraction of 8Gy, 21 (11.80%) 10 fractions of 3Gy. Months with the highest incidence by COVID-19 were used shortest divisions and single session treatments. Conclusions: Cancer pain is one of the main reasons for radiotherapy treatment. During the pandemic, patients have been diagnosed in more advanced stages, in many cases as metastatic disease. Therefore, the need for treatment has increased. The option of shorter schedules is beneficial for the patient, since by reducing visits to the hospital the risk of infection decreases, without worsening the effectiveness of the treatment. (Table Presented).

Decrease in Pain Perception During Acute SARS-CoV-2 Infection: A Case Series

Background/aims: Many reports have described pain appearance or an increase of chronic pain concomitant to SARS-CoV-2 infection. Here, we describe the cases of three patients with chronic cancer pain, in which COVID-19 was associated with a dramatic reduction/disappearance of pain. Methods: Descriptive report of three oncological patients with chronic pain hospitalized in the contexte of acute COVID-19. Clinical information was personally retrieved by the authors, who also examined the patients. Brain MRI was performed when deemed necessary by the referring physician. Autopsy, when conducted, was performed at the request of family members. All three patients were hospitalized between October 2020 and January 2021 Results: In this case series we describe, for the first time, a group of patients with chronic oncological pain, in which severe SARS-CoV-2 infection resulted in a temporary decrease of pain perception. It should be noted that despite optimal treatment, pain was insufficiently controlled in all cases prior to the infection. Patient 1 suffered from medullary compression at D2 due to probable perivertebral metastasis associated with bone lysis;patient 2 suffered from painful rib metastases;patient 3 suffered from neoplastic infiltration of the rectum from a bladder adenocarcinoma. None of the patients had impaired cognitive function that could have compromised their evaluation of pain. None of the patients complained of dyspnea at the moment of hospitalization;moreover, the reappearance of pain in patient 3 coincided with recovery from COVID-19 and de novo onset of dyspnea. Conclusions: To our knowledge, thisis the first case series reporting an acute reduction in pain perception in COVID-19. We believe further investigation is mandatory, as it could shed new light on the mechanisms of pain perception and modulation.

Opioid Dispensing Patterns from a Tertiary Care Cancer Hospital during the Nationwide Lockdown in COVID-19 Pandemic.

INTRODUCTION: During the current COVID-19 crisis, striking a balance between adequate pain relief in advanced malignancy patients and avoiding hospitals due to fear of contracting the infection has been the biggest challenge for patients as well as palliative care physicians. This study explored the trends in opioid dispensing for cancer pain before and during the lockdown. METHODS: The trends were calculated based on an analysis of quantity of all opioids dispensed. March 24, 2020, was considered as a cutoff for analyzing before and during lockdown period dispensing trends. No information regarding individual patients was retrieved in the current study. RESULTS: There was a decrease in total morphine, tramadol, and fentanyl patch dispensing parallel to decrease in total number of patients visiting the outpatient department. However, there was a statistically significant increase in per capita opioid dispensing during the lockdown period. There was also an increase in the proportion of cancer pain patients that were dispensed morphine during the lockdown. CONCLUSION: Despite the lockdown, the palliative care team at Institute Rotary Cancer Hospital has continued to provide adequate pain relief to patients that could manage to reach the center. Policy-makers need to be cognizant of the pain relief needs of cancer patients in times when accessing hospitals is becoming increasingly difficult. Cancer-related pain and mortality could well be the next pandemic once the current COVID-19 begins to reduce.

Strengths and Weaknesses of Cancer Pain Management in Italy: Findings from a Nationwide SIAARTI Survey.

OBJECTIVES: Despite guidelines, a large percentage of cancer patients continue to suffer from ineffectively treated pain. The authors undertook this survey to assess the strengths and weaknesses of cancer pain management in Italy. DESIGN: This was a prospectively administered survey. PARTICIPANTS: The participants were anesthesiologists of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). INTERVENTION: A 58-item questionnaire covered the demographics and features of cancer pain management in the Italian context. RESULTS: The authors received responses from 611 pain therapists of 279 centers. Only 22% of physicians are exclusively pain therapists. Seventy-five percent are specialists in anesthesiology, intensive care, and pain medicine. Most pain centers are hospital or university facilities (78%). The strengths of cancer pain management in Italy are the careful opioid prescriptions, the use of strategies for the treatment of neuropathic pain, patient/healthcare provider partnerships, and breakthrough cancer pain management. Weaknesses to be addressed include poor adherence to guidelines, inadequate attention toward the patient's quality of life, insufficient use of minimally invasive techniques, lack of teamwork approaches, inappropriate timing of pain specialist engagement, and poor telemedicine use. CONCLUSIONS: Despite several strengths, further efforts are needed to improve the care of patients suffering from cancer pain in Italy.

Impact of Cannabis Use on Least Pain Scores Among African American and White Patients with Cancer Pain: A Moderation Analysis.

INTRODUCTION: Based on many published reports, African American patients with cancer experience higher pain severity scores and lower pain relief than White patients. This disparity results from undertreatment of pain and is compounded by low adherence to prescribed non-opioid and opioid analgesics among African American patients with cancer. While nearly one in four patients use cannabis to manage cancer-related symptoms, less is known about how cannabis use influences pain relief in this patient population. METHODS: This study is based on preliminary data from an ongoing study of longitudinal outcomes of opioid therapy among African American and White patients with cancer. Linear mixed-effects models were utilized to assess the interaction of race and cannabis use on pain relief using "least pain" item scores from the Brief Pain Inventory (BPI) averaged across three time points. Models were adjusted for sociodemographic and clinical variables. RESULTS: This analysis included 136 patients (49 African American, 87 White). Overall, 30.1% of the sample reported cannabis use for cancer pain. The mean "least pain" score on BPI was 3.3 (SD=2.42) on a scale of 0-10. African American patients had a mean "least pain" score 1.32±0.48 units higher (indicating lower pain relief) than White patients (p=0.006). Cannabis use did not have a significant main effect (p=0.28). However, cannabis use was a significant moderator of the relationship between race and "least pain" (p=0.03). In the absence of cannabis use, African Americans reported higher "least pain" scores compared to Whites (mean difference=1.631±0.5, p=0.001). However, this disparity was no longer observed in African American patients reporting cannabis use (mean "least pain" difference=0.587±0.59, p=0.32). CONCLUSION: These findings point to the possible role of cannabis in cancer pain management and its potential to reduce racial disparities. These findings are preliminary and further research into the role of cannabis in cancer pain outcomes is needed.

Pain Management Revisited.

Now that the SARS-CoV-2 virus and its variants have altered clinical oncology practice as we know it, let's return to a familiar focus from the Core Curriculum for Oncology Nursing-pain management. Much has happened during the past two years that influences the effective management of pain in patients with cancer-not the least of which is a clinical environment that has been changed by the COVID-19 pandemic.

Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings.

BACKGROUND: mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS: in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS: cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION: apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.

Intravenous Ketamine for Cancer Pain Management, Including Flares During the COVID-19 Pandemic: A Retrospective Study.

OBJECTIVES: Cancer-related neuropathic pain (CNP) affects an increasing proportion of cancer patients, given improved survival, but it remains difficult to treat. There are no studies on an extended intravenous ketamine protocol and its synergies with common neuropathy treatments to treat CNP. This study aims to 1) evaluate the safety and effectiveness of an intravenous ketamine protocol to treat refractory CNP and 2) uncover synergies between ketamine and common neuropathy treatments. METHODS: This is a single-center, retrospective review of 57 patients and 192 infusions, with prospective follow-up on 14 enrolled patients during the coronavirus disease 2019 (COVID-19) pandemic. RESULTS: The etiologies of CNP were as follows: 13 from tumor compression, 25 with chemotherapy-induced peripheral neuropathy, 13 from surgery, and 6 from radiation therapy. Overall, 42 of 57 patients (73.7%) were responders, and 71.8% of responders received >3 weeks of pain relief on their last infusion. Analysis of adjuvant treatments revealed that the combination of serotonin-norepinephrine reuptake inhibitors and ketamine resulted in an increase in responders compared with nonresponders (P < 0.01). Adverse events occurred in 32 of 192 infusions (16.7%). All side effects self-resolved or resolved with intervention per the adverse events protocol. During the pandemic, all 14 currently enrolled patients did not receive ketamine infusions. Thirteen of the 14 patients returned to baseline pain, with 61.5% increasing medications. All experienced worsened function, mobility, mood, or anorexia. CONCLUSION: Intravenous ketamine may be a safe and effective adjuvant treatment for CNP, especially with serotonin-norepinephrine reuptake inhibitors. Larger, prospective studies are warranted and should explore parameters to help prognosticate response to ketamine infusions.

Cancer Patients' Perceived Difficulties Filling Opioid Prescriptions After Receiving Outpatient Supportive Care.

CONTEXT: Limited access to opioids for patients with cancer has been reported as a potential unintended consequence of recent regulations restricting opioid use and prescribing practices. To our knowledge, there are a limited number of peer-reviewed studies that evaluate the perceived difficulties of the patients with cancer when filling their opioid prescription. To understand these difficulties, we surveyed patients receiving opioids in our outpatient supportive care center (SCC). OBJECTIVES: The primary objective of this study was to evaluate cancer patients' perceptions of overall difficulties when filling their opioid prescription. Secondary objectives included determining associations between patient characteristics and difficulty and comparing difficulty between filling opioid and nonopioid prescriptions. METHODS: Patients with cancer receiving opioids that had been seen two times or more at our SCC were asked to complete a survey. The information collected included patient demographics, clinical characteristics, and patients' experiences filling their opioid prescription. RESULTS: The patients' median age was 60 years; 54% were female and 69% were white. Forty-four patients (32%) reported that they have experienced difficulty filling their opioid prescription. More than 25% of those 44 patients perceived difficulty from interactions with the pharmacy and/or pharmacist. Forty-six patients (33%) reported more difficulty filling their opioid prescriptions than filling their nonopioid prescriptions. CONCLUSION: This study provides evidence that patients with cancer visiting our SCC perceived difficulties obtaining their opioid prescriptions. The results suggest that negative interactions with the pharmacy and/or pharmacist contribute to their perceived difficulty. Additional research is needed to further characterize the contributors of the difficulties patients with cancer face in filling their opioid prescriptions.