Toronto, Canada—By employing restrictive prescribing, clinicians can significantly reduce opioid use in patients with gynecologic cancers, all the while maintaining high patient pain management satisfaction, according to data prepared for presentation at the 2020 SGO Annual Meeting on Women’s Cancer

“Our goal was to evaluate patient satisfaction in gynecologic oncology patients undergoing surgery managed with a restrictive opioid-prescribing algorithm (ROPA),” said lead investigator Teresa Kate-Leslie Boitano, MD, University of Alabama at Birmingham, and colleagues, who conducted a retrospective cohort study of patients with gynecologic cancers undergoing any surgical procedures between October 2018 and August 2019 (n = 1369). Patient demographics (eg, age, BMI, and surgical procedures) were similar between the different study groups.

Dr Boitano et al also included a control group (n = 1321) without restrictive prescribing practices which was identified from October 2016 to September 2017.

Before surgery, patients were educated about pain management goals, the ROPA, and how to dispose of leftover opioids. Prescriptions were written in a standardized fashion upon discharge based on surgical complexity (4-tiered system) and 24-hour post-surgery opioid use.

For the first 6 months, patients completed surveys at their postsurgery visits that evaluated patient satisfaction, number of remaining pills, and leftover opioid disposal methods. SPSS Statistics (v.24) was used for statistical analysis.

At discharge, the average number of pills prescribed was significantly lower in the ROPA group versus the control group (30.5 pills vs 11.3 pills, respectively; P <.001). Among 694 patients asked to fill out surveys, the completion rate was 58.5%.

According to the survey responses, 95.8% of the time patients were “very satisfied” or “somewhat satisfied” with their post-surgery pain management, with 16.2% of them noting that they did not fill their opioid prescription at all. Approximately 54% of patients had leftover pills, including 35.6% who disposed of them, with the most common method being toilet-flushing (71.2%) and least common being dropping them off at a disposal center (6.8%).

Of note, approximately 11% of all patients needed an opioid prescription refill.

“A restrictive prescribing practice allows for a significant reduction in the amount of opioids prescribed, maintaining high patient satisfaction with pain management,” Dr Boitano and colleagues said.

“Even with restrictive practices, 16% of patients did not fill their opioid prescription due to adequate pain control with over-the-counter pain medications. Despite increased education, only 35% of patients disposed of leftover opioids,” they concluded.—Hina Porcelli

Boitano TKL, Lipking K, Smith HJ, et al. Patient satisfaction of a restrictive opioid prescribing algorithm in gynecologic oncology patients undergoing surgery. Presented at: the 2020 SGO Annual Meeting on Women’s Cancer; March 28-31, 2020; Toronta, Canada. Abstract 48.