Impact of an embedded onco-palliative care clinic on urine drug testing in thoracic oncology

Urine drug testing (UDT) is recommended, yet underutilized, for patients receiving opioids for cancer pain. The primary aim of this study was to evaluate the impact of an embedded onco-palliative care clinic on UDT among patients with lung cancer. The number of patients tested, the timing of the first UDT, the incidence of unexplained UDT results, testing frequency, and substances detected on UDT were explored.

This is a single-institution retrospective study of patients diagnosed with any stage thoracic malignancy who began urine drug testing 1 year before (pre-cohort) and 1 year after (post-cohort) implementation of an embedded thoracic oncology-palliative care clinic in Columbus, Ohio, USA, on September 5, 2018. Confirmatory UDT was routinely ordered for any patient receiving opioids prescribed by palliative care or via ad hoc testing by oncology providers regardless of palliative care referral status.

More patients completed UDT after implementation of an embedded onco-palliative care clinic (pre-cohort, n = 61; post-cohort, n = 182). Pre-cohort patients began UDT closer to death with median survival of 5.2 months after first UDT (post-cohort, 10.9 months; p < 0.0001). While a larger proportion of post-cohort patients completed > 1 UDT (pre, 26.6%, post, 46.7%; p < 0.01), there was no significant difference in the proportion of patients experiencing an unexplained UDT result (pre, 9.8% vs. post, 11.0%, p = 0.80).

Implementation of an embedded onco-palliative care clinic was associated with a significant increase in use and earlier initiation of UDT among patients receiving care in a thoracic oncology clinic.