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Providers' Barriers to Buprenorphine Prescribing for Cancer-Related Pain
Katarina E AuBuchon1, KerriAnn M Boanca2, Nikhitha Muthineni1
1Department of Oncology (K.E.A., N.M., M.A.E.), Georgetown University, Washington, District of Columbia.
Background:
Full-agonist opioids are standard for treating cancer-related pain. However partial-agonist opioids (e.g., buprenorphine) are promising treatments with fewer side effects and a stronger safety profile. However, it is unclear how oncology and palliative care providers (Medical Doctors, Advanced Practice Providers, etc.) perceive prescribing of buprenorphine for cancer-related pain.
Methods:
Participants (N = 42; 50% oncology) at a single healthcare system with multiple hospitals completed a one-time web-delivered survey assessing reported opioid prescribing patterns and barriers to buprenorphine prescribing for cancer-related pain. Independent samples t- and chi-square tests compared palliative and oncology providers' opioid prescribing and barriers to buprenorphine use; we examined how barriers related to intentions to prescribe buprenorphine with correlations.
Results:
Most participants reported awareness of buprenorphine for cancer-related pain (81%), and that buprenorphine is effective for treating cancer-related pain (80%), but few reported prescribing it (oncology 0%; palliative 5%). Oncology providers reported lack of knowledge about buprenorphine prescribing. Palliative care providers reported opioid stigma (61.7%) and patients' difficulty obtaining buprenorphine (47.6%) were barriers. Prescribing participants' future intentions to prescribe buprenorphine for cancer-related pain was significantly associated with endorsement that buprenorphine is as effective as (r = .53, P = .005), and that it causes fewer side-effects relative to (r = .59, P < .001) other opioids.
Discussion:
Our study identified knowledge gaps in cancer care teams about buprenorphine for cancer-related pain. Future research should consider education for oncology teams on buprenorphine, and how oncology and palliative care teams can benefit from working together to reduce stigma when communicating with patients about buprenorphine.
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