Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease

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  • 1 National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania;
  • 2 American Society of Clinical Oncology, Alexandria, Virginia;
  • 3 Washington University School of Medicine, St. Louis, Missouri;
  • 4 Northwestern University, Feinberg School of Medicine, Chicago, Illinois;
  • 5 American Society of Hematology, Washington, DC;
  • 6 Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC;
  • 7 Centers for Disease Control and Prevention, Atlanta, Georgia;
  • 8 University of Pennsylvania, Philadelphia, Pennsylvania; and
  • 9 University of Texas MD Anderson Cancer Center, Houston, Texas.
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Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and American Society of Clinical Oncology each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.

Submitted October 25, 2019; accepted for publication November 12, 2019.

Publication: This is a dual publication with JCO Oncology Practice.

Disclosures: Ms. Schatz has disclosed that her spouse holds stock in TransEnterix, Editas Medicine, Amgen, Adamas Pharmaceuticals, UnitedHealth, Intuitive Surgical, and Akers Biosciences. Dr. Darbari has disclosed that she is a scientific advisor for Novartis, and served on the advisory board for Global Blood Therapeutics. Dr. Bruera has disclosed that he receives research support from Helsinn Health. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the official position of the National Comprehensive Cancer Network, American Society of Clinical Oncology, American Society of Hematology, or Centers for Disease Control and Prevention.

Correspondence: Alyssa A. Schatz, MSW, National Comprehensive Cancer Network, 3025 Chemical Road, Suite 100, Plymouth Meeting, PA 19462. Email: Schatz@nccn.org

 This article was updated from the print version: reference 17 was updated with a new url.

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