Buprenorphine for the Management of Cancer Related Pain and Facilitation of Survivorship Transition

Key Message: Buprenorphine, a partial mu-opioid receptor agonist is approved by the Food and Drug Administration for the management of acute and chronic pain, in addition to opioid dependence. In comparison to traditional opioid medications, the side effect profile of buprenorphine is lower and may be better tolerated by patients.

Abstract: Background
The demand for complex cancer care continues to rise across the United States, with an estimated projection of 26 million individuals expected to be diagnosed with cancer by the year 2040 (1). A parallel need for supportive and palliative oncology care exists to ensure optimal patient quality of life. Cancer-related pain, a common symptom during active disease or remission, presents management challenges especially in the setting of misuse and substance use disorders (2). The purpose of this quality improvement project was to demonstrate the utility of buprenorphine in the treatment of cancer related pain as applied within a multidisciplinary health care team.
Methods
The supportive and palliative oncology clinic at Vanderbilt-Ingram Cancer Center is comprised of multiple health care disciplines including specialty physicians and nurse practitioners in palliative care, hematology/oncology, psychology oncology, interventional pain management, as well as pharmacy and nursing. As a collaborative team, buprenorphine was prescribed to successfully taper cancer survivors with chronic cancer-related pain from full opioid medications as guided by the American Society of Addiction Medicine and the Centers for Disease Control and Prevention (3-4). Patients selected demonstrated high risk for misuse or had a history of opioid use disorder (OUD).
Implications & Lessons Learned
Three case studies highlight the favorable properties and efficacy of buprenorphine for patients with cancer-related pain. Clinician decision making in concert with patients yielded reductions in opioid use while implementing evidence-based, multimodal pain management plans of care. Case studies examine scenarios of patients with high risk for misuse, head and neck cancer with OUD, and a history of cancer. Buprenorphine was well tolerated and effective in managing cancer pain without use of full opioid medications. Further, buprenorphine facilitated opioid tapering for patients with stable cancer related pain or no evidence of disease without functional compromise.

References: 1. Tonorezos, E., Devasia, T., Mariotto, A. B., Mollica, M. A., Gallicchio, L., Green, P., Doose,
M., Brick, R., Streck, B., Reed, C., de Moor, J. (2024). Prevalence of cancer survivors in the United States. J Natl Cancer Inst. 1;116(11):1784-179

2. Hande, K., Butler, T., Cones, B., Kasel, M., Jackson, H. (2024). Managing cancer pain in patients with opioid use disorder. Journal for Nurse Practitioners 20 (10): Article 104858.

3. American Society of Addiction Medicine (2020). National practice guideline for the treatment of opioid use disorder: 2020 focused update. Journal of Addiction Medicine (2S Suppl 1):1-91.

4. Dowell, D., Haegerich, T. M., Chou, R. et al. (2022). CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. Morbidity and Mortality Weekly Report 71(3), 1-95.