Disclosures: Tiffany N. Su, MD: Nothing to disclose

Case Description: Cancer survivors are a growing population with opioid use disorder (OUD). Providers may continue opioid medications despite cancer remission, as clinical findings may be complicated by difficulty identifying a clear pain generator. This case report demonstrates the importance of increased awareness about OUD and consideration of medication assisted therapy (MAT) in cancer survivors.

Setting: Veterans Affairs Hospital

Patient: A 57-year-old man with history of retroperitoneal liposarcoma in remission since 2016 presented to the emergency department at a VA Hospital fifteen times between March 2017 and October 2018 with severe abdominal pain, nausea, and vomiting. He was admitted five times and seen by multiple specialists, including gastroenterology, hematology-oncology, palliative care, and pain management. Because of his pain and recent remission, he underwent comprehensive evaluations, including computed tomography of the abdomen and pelvis five times, esophagogastroduodenoscopy, and positron emission tomography scan. No evidence of recurrent malignancy was found.

Assessment/Results: The patient was provided high dose intravenous opioids with symptomatic relief at each encounter. Pain Medicine providers identified he was consistently presenting prior to the anticipated renewal of his opioids. In the outpatient setting, the patient was prescribed hydromorphone 4 mg tabs every 4 hours and fentanyl 5 mg patches every 3 days monthly. His symptoms were felt to be consistent with opioid withdrawal. Given the lack of indication for continued opioid therapy, he was determined to be a candidate for MAT.

Discussion: He was tapered off opioids and started on suboxone 4 mg twice daily under the guidance of addiction psychiatry with significant improvement in his symptoms. Since starting MAT, the patient has not presented to the ED for additional care.

Conclusion: This case report demonstrates the importance of increased awareness about OUD and consideration of MAT in cancer survivors.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/medication-assisted-therapy-in-cancer-survivors-with-pain/