Impact of NCCN Guideline Adherence in Adult Cancer Pain on Length of Stay. (3rd April 2022)

• Record Type: Journal Article
• Authors: Dela Pena, Jacqueline C.; Marshall, Vincent D.; Smith, Michael A.
• Is Part Of: Journal of pain & palliative care pharmacotherapy. Volume 36:Number 2(2022)
• Page Start: 95
• Page End: 102
• Publication Date: 2022-04-03
• Subjects: Cancer pain -- opioids -- NCCN -- length of stay; Pain -- Treatment -- Periodicals; Analgesia -- Periodicals; Palliative treatment -- Periodicals; Analgesics -- Therapeutic use -- Periodicals; Pain -- drug therapy -- Periodicals; Pain -- prevention & control -- Periodicals; Palliative Care -- Periodicals; Analgesics -- therapeutic use -- Periodicals; 616.994
• DOI: 10.1080/15360288.2022.2066746
• Languages: English
• ISSNs: 1536-0288

Abstract

Abstract: To improve the management of cancer related pain, the National Comprehensive Cancer Network (NCCN) publishes the Adult Cancer Pain guideline on an annual basis. However, a large majority of oncology patients still report inadequate pain control. Single-center, retrospective cohort study of adult patients admitted for uncontrolled pain or pain crisis between 3/1/19 and 06/30/20 were assigned to cohorts of either adherent or non-adherent to NCCN guideline recommendations for management of pain crises based on their initial opioid orders. Patients must have reported a pain score >/= 4 and received at least one dose of opioids within 24 hours upon admission. The length of stay (LOS), pain scores, and naloxone administration were compared between both groups. Patients in the adherent group had a shorter median LOS (3.7 days [range: 1 to 18.93] vs 5.4 days [range: 1.45 to 19.64 days], p = 0.04). Patients that received lower doses than recommended had longer LOS compared to adherent group (6.1 vs. 3.7 days; p = 0.009). When adjusted for confounders, this significance did not remain. The lowest reported pain score within 24 hours of admission was lower in the adherent group (median 3 vs 4, p = 0.04). Predictors of LOS included opioid tolerance and a pain or palliative care consult. Adherence to NCCN guidelines for acute pain crisis management in adult patients with cancer remains poor. Patients who received guideline adherent initial opioid regimens demonstrated a trend toward a shorter LOS. Opioid-tolerant patient outcomes remain inadequate; appropriate pain management for these patients need to improve.