The Role of Informatics in Implementing Guidelines for Chronic Opioid Therapy Risk Assessment in Primary Care: A Narrative Review Informed by the Socio-Technical Model.

Approximately 2 million Americans live with opioid use disorder (OUD), most of whom also have chronic pain. The economic burden of chronic pain and prescription opioid misuse runs into billions of dollars. Patients on prescription opioids for chronic non-cancer pain (CNCP) are at increased risk for OUD and overdose. By adhering to the Center for Disease Control and Prevention (CDC) opioid prescribing guidelines, primary care providers (PCPs) have the potential to improve patient outcomes. But numerous provider, patient, and practice-specific factors challenge adherence to guidelines in primary care. Many of the barriers may be mediated by informatics interventions, but gaps in knowledge and unmet needs exist. This narrative review examines the risk assessment and harm reduction process in a socio-technical context to highlight the gaps in knowledge and unmet needs that can be mediated through informatics intervention.

Chemotherapy-induced nausea/vomiting and functional status in women treated for breast cancer.

Nausea and vomiting are among the most distressing symptoms for cancer patients treated with chemotherapy even with the widespread use of 5-HT3 antagonists. Chemotherapy-induced nausea and vomiting (CINV) is composed of 4 major components: acute nausea, delayed nausea, acute vomiting, and delayed vomiting. Determining the relationship of each component of CINV on the functional status of women undergoing chemotherapy for breast cancer was the purpose of this study. This longitudinal, descriptive study recruited 303 patients with breast cancer undergoing chemotherapy from 40 study sites in the United States. Reliable and valid measures of CINV and functional status were employed. Patients demonstrated significant decreases in the following aspects of functional status as measured by the SF-36: physical functioning (P < .0005), role limitations due to physical problems (P = .003), general health (P = .029), vitality (P < .0005), and social functioning (P = .001). The pattern of reduction in usual activities and increase in hours of resting correlated best with 2 components of CINV--delayed nausea and delayed vomiting (P < .0001, each). The results of this study suggest that control of delayed CINV may contribute to the functional improvement of women receiving chemotherapy for breast cancer.

Exercise manages fatigue during breast cancer treatment: a randomized controlled trial.

Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence-based treatments are available to manage this distressing side-effect. The purpose of this multi-institutional randomized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer. Sedentary women (N=119) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were randomized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment. Of participants randomized to exercise, 72% adhered to the exercise prescription; 61% of the usual care group adhered. The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39% of the usual care group exercised and 28% of the exercise group did not. When exercise participation was considered using the data analysis method of instrumental variables with principal stratification, a clinically important and statistically significant (p=0.03) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated. Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment.

Adherence to moderate-intensity exercise during breast cancer therapy.

PURPOSE: The aims of this pilot study were the following: 1) to examine patterns of adherence to a brisk walking program in women receiving adjuvant chemotherapy or radiation therapy for newly diagnosed breast cancer using a prospective, randomized, controlled experimental design; 2) to examine the influence of disease symptoms and treatment side effects on exercise levels; and 3) to suggest methods that may improve future clinical trials of moderate-intensity exercise in similar populations. DESCRIPTION OF STUDY: Fifty-two patients with newly diagnosed breast cancer were randomly assigned to one of two treatment arms: usual care or usual care plus exercise. Those assigned to the exercise group received a standardized, self-administered, home-based brisk walking intervention in addition to usual care. Each day subjects completed self-report diary forms that elicited information about activity levels, and the occurrence of symptoms and side effects during cancer treatment. RESULTS: Analyses of self-reported daily activity levels revealed a diffusion of treatment effect. Fifty percent of the usual-care group reported maintaining or increasing their physical activity to a moderate-intensity level, while 33% of the exercise group did not exercise at the prescribed levels. Analyses of self-reported disease symptoms and treatment side effects did not reveal clinically meaningful differences between the two groups. CLINICAL IMPLICATIONS: The results of this study suggest that women who exercised regularly before receiving a breast cancer diagnosis attempted to maintain their exercise programs. Women who lead sedentary lifestyles may benefit from a structured exercise program that includes information and support related to exercise adherence strategies.

Chemotherapy-induced nausea and vomiting.

Nausea and vomiting (N&V) is among the most distressing side effects of chemotherapy, despite the development of more efficacious antiemetic agents. As many as 60% of patients who receive cancer chemotherapy experience some degree of N&V. However, the actual incidence is difficult to determine with accuracy because of the variety of drugs, doses, and health conditions of the patients who receive cancer treatments. This article examines the state of the science related to chemotherapy-induced nausea and vomiting and reviews both pharmacologic and behavioral strategies that have demonstrated efficacy in managing these distressing symptoms.