Pain and Prescription Opioid Use among Survivors of Hematologic Malignancies: A Mixed-Methods Approach

Prescription opioids have significantly contributed to the devastating consequences of America’s opioid epidemic, including opioid addiction, overdose, and death. In the context of the opioid epidemic, the American Society of Hematology released a policy statement in 2018 advocating for research aimed at furthering the understanding of pain management in hematologic conditions, including hematologic malignancies (HM). Additionally, treatment advances for HM have dramatically improved life expectancy, necessitating greater focus on long-term quality of life and cancer pain management. However, understanding of pain and pain management in HM is poor. Therefore, this dissertation aims to examine a critical gap by exploring issues related to pain and pain management among patients with HM through mixed methods research. In two qualitative studies, semi-structured interviews were used to gain insight regarding experiences with HM-related pain and pain management as well as attitudes towards opioids among adult patients with HM marginalized due to race/ethnicity and/or socioeconomic status. In one quantitative study, administrative claims data was used to explore opioid use and opioid-related harms among adult patients with different types of HM. In the qualitative studies, we found that pain related to HM can cause significant burden on patients’ lives throughout diagnosis, treatment, and survivorship. However, fears and stigmatized views of opioids can conflict with marginalized patients’ needs to manage debilitating HM-related pain. Negative attitudes towards opioids were shaped by the opioid epidemic and reduced willingness to seek out or use analgesics. These findings help expose patient-level barriers to optimal HM pain management, revealing attitudes and knowledge to be targeted by future pain management interventions in HM. Results from the quantitative study demonstrated that high-risk opioid use was prevalent among patients with HM and significantly increased the risk of opioid-related harms. These findings highlight the importance of continually reevaluating and monitoring pain and opioid use throughout HM treatment and survivorship, particularly for patients who are likely to achieve long-term survival or cure. Continued research in the area of pain in HM may help to inform evidence-based guidelines addressing management of persistent pain and optimize analgesic interventions in a population with complex health needs.