Pediatric Oncology Providers’ Perceptions on Pain Management and Opioid Use for Adolescents and Young Adults With Cancer: A Qualitative Study

Background: Over 89,000 adolescents and young adults (AYAs) are diagnosed with cancer every year in the United States, and despite high survival rates, AYAs continue to experience the late effects of cancer and its treatments into survivorship. Pain, cited as the most distressing, impairing, and undertreated symptom during and after active treatment, is a common concern for AYAs with cancer and a challenge for oncology providers to manage. First-line pain treatments often include prescription opioids, but there is limited evidence to support the efficacy of long-term opioid use to manage pain among AYAs, along with increased risk of opioid-related negative consequences. Given the relative lack of research in this area, there is an opportunity to better understand how oncology providers think about and navigate chronic pain management and mitigate risk for opioid-related negative outcomes. Method: Therefore, we conducted a semi-structured qualitative study with 14 pediatric oncology providers, assessing current pain management practices, decision-making, attitudes and perspectives, and challenges to providing safe and effective pain management for AYA oncology patients. Interviews were summarized using a Rapid Qualitative Analysis framework. Results: Results provided support for three themes: perceptions about pain and pain management needs for AYAs with cancer; pharmacological and nonpharmacological treatments for cancer-related pain; and education, standardization, and challenges of opioid pain management. Conclusions: There are a number of existing barriers to AYA cancer-related pain management in the oncology setting. Oncology providers are providing primary pain management for their patients, but should consider referral to pain specialists when available. Better characterization of cancer-related pain can ideally be leveraged to identify those patients at highest risk for chronic pain and its consequences in survivorship, opening the possibility of developing tailored prevention and intervention strategies.