®, has been with MJH Life Sciences since 2016. She has served as an editor on both 

. Brielle is a graduate from The College of New Jersey, where she is pursuing a Master’s in Public Health (part-time). Outside of work, she enjoys spending time with family and friends, CrossFit, and wishing she had the grace and confidence of her toddler-aged daughter. Follow Brielle on Twitter @Brielle_Benyon.

Brielle Benyon

Patients with late-stage cancer are being prescribed fewer opioids and tend to go to the emergency room for pain more often, according to recent research published in the 

The study, which was conducted by researchers from the Dana-Farber Cancer Institute, looked at opioid prescriptions of 270,632 patients on Medicare who had late-stage cancer and either died or were enrolled in hospice between 2007 and 2017. Findings showed a 34% reduction in the number of opioid prescriptions filled per patients and a 38% reduction in the total dose of opioids filled. This was the sharpest decrease in long-acting opioids.

The fact that there are fewer opioid prescriptions does not necessarily correlate with better pain management through other venues. In fact, it may be the opposite – the researchers also discovered a 50.8% increase in emergency room visits for pain.

“We weren’t able to connect the trends about opioid access and emergency visits, so we don’t know if there’s a causal link here, but it’s certainly troublesome,” Dr. Andrea C. Enzinger, study author, medical oncologist at the Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School, said in an interview with CURE®.

“(The findings) suggest that patients may be having to seek out pain-related care in the emergency department because they simply don’t have the medicines they need at home, or they cannot get them in time.”

In the midst of the ongoing opioid epidemic, the government and insurers have put regulations on opioid use, such as written opioid agreements with patients, more drug monitoring, the requirement for prior authorizations and more. These policies not only make it more difficult for clinicians to prescribe opioids, but also for patients to actually get the prescribed drugs, too.

Stigma and fear of addiction could play a role in decreased opioid use, too. Enzinger said that she oftentimes sees patients who have horrible pain but are apprehensive to use opioids because they do not want to become addicted.

“There’s been huge media coverage about the opioid epidemic, mainly focusing on the risks of opioid use, and it has really sensationalized the problem. There’s been very little attention to legitimate and real needs for opioids,” Enzinger said. “The fact of the matter is, if someone has a few months to live, the risk of addiction is really not relevant at all.”

This may not be the case with earlier-stage cancer, though. Enzinger said that patients with better prognoses should carefully weigh the pros and cons of long-term opioid use and noted that there is not one approach that will work for everyone.

“Calculations are different for patients who are in a different phase of their cancer care. There’s not a one-size-fits-all (method), but there are definitely patients for whom opioid therapy is vitally important. We really need more research to understand what the risks are, how to mitigate those risks and how to talk to patients about monitoring if they are worried about risk of opioid misuse disorder,” she said.

Enzinger said that there needs to be clearer messaging about opioid use, especially for patients with late-stage cancer. That can start with patients having open conversations with their health care team.

“Patients need to be upfront with their doctor when their pain is not well managed,” Enzinger said. “They need to get their doctor’s attention when their quality of life and their physical functioning and activity levels are changing.”

For more news on cancer updates, research and education, don’t forget to 

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Fewer opioids have been prescribed, but there have been more emergency room visits for pain in patients with cancer who have poor prognoses.

Pain Management Has Worsened for Patients With Late-Stage Cancer

The Food and Drug Administration (FDA) approved Keytruda (pembrolizumab) plus chemotherapy (carboplatin and paclitaxel then doxorubicin or epirubicin and cyclophosphamide) for the treatment of patients with high-risk, early-stage triple-negative breast cancer (TNBC), according to Merck, the manufacturer of the immunotherapy agent.

Per the approval, the Keytruda/chemotherapy regimen should be given before breast cancer surgery (the neoadjuvant setting) and then the anti-PD-1 therapy should be given alone after surgery (the adjuvant setting).

“We are proud to offer a new treatment option for patients faced with this challenging cancer. This neoadjuvant and adjuvant combination with Keytruda is the first immunotherapy regimen to be approved in high-risk early-stage TNBC, marking a meaningful milestone for the breast cancer community,” Dr. Vicki Goodman, vice president of clinical research at Merck Research Laboratories, said in a press release.

The approval is based on findings from the KEYNOTE-522 clinical trial, which demonstrated that Keytruda plus chemotherapy before surgery and continued as a single agent after surgery significantly improved event-free survival (the time where patients survived and had no cancer-related progression) compared to just neoadjuvant chemotherapy. Additionally, trial results showed that the newly approved regimen resulted in a 37% decrease in the risk of disease progression before definitive surgery, local or distant recurrence, another cancer or any-cause death.

“Even when TNBC is diagnosed early, 30% to 40% of patients will suffer cancer recurrence after standard neoadjuvant chemotherapy and surgery,” Dr. Joyce O’Shaughnessy, chair of Breast Cancer Research ay Baylor University Medical Center, Texas Oncology, U.S. Oncology in Dallas, said in the release. “Therefore, there is a high unmet need for new treatment options. Today’s approval is very welcome news and has the potential to change the treatment paradigm by now including an immunotherapy as part of the regimen for patients with high-risk early-stage TNBC.”

The approval also marks a welcome new treatment option for subgroups of patients who are disproportionately affected by TNBC. “Triple-negative is a difficult-to-treat type of breast cancer that unfortunately is more common in the U.S. in younger women and in Black women,” Goodman said in the release.

In November 2020, Keytruda plus chemotherapy was granted an accelerated approval for patients who had locally recurrent or unresectable (not eligible for surgery) metastatic TNBC, whose tumors expressed PD-L1 – the biomarker that Keytruda inhibits, thus activating the immune system to attack the cancer. Now, the FDA converted the accelerated approval to a full approval.

Since Keytruda kickstarts the immune system to find and fight cancer cells, patients should be aware of the treatment’s immune-related side effects, which could be fatal and may include: pneumonitis, colitis, hepatitis, endocrinopathies (hormone problems), nephritis, dermatologic reactions, solid organ transplant rejection and complications of allogeneic hematopoietic stem cell transplantation. It is recommended that patients should talk to their health care team immediately if they experience any side effects from Keytruda, which can occur at any time during or after treatment.

The approval of the immunotherapy agent “has the potential to change the treatment paradigm” in high-risk, early-stage TNBC.

FDA Approves Keytruda/Chemo for Triple-Negative Breast Cancer

Patients with cancer may seek medical marijuana for multiple reasons. In his practice, Dr. Ali J. Zarrabi, a physician at the Winship Cancer Institute and assistant professor in the Emory University School of Medicine, said in an interview with CURE® that patients often want to try cannabis to treat symptoms of cancer treatment, as well as a way to feel more in control of their treatment.

Where legal, cannabis could be promising in providing this symptomatic relief. However, patients should not assume that marijuana can actually treat their disease, as there is currently no solid evidence indicating that it can treat cancer. When patients bring this up, Zarrabi uses the opportunity to open up a broader discussion about patient values and goals of care.

So the most common question I get in my clinic is, ‘I'm on a lot of medicines. I'm on four different nausea pills. I'm on two different sleeping pills. I'm on opioids. I'm on whatever opioid it is – oxycodone, oxycontin, fentanyl, methadone, etc. And my friend, my family member, sometimes my oncologist suggested that I try cannabis to potentially treat many of the symptoms and distress from my disease.’

And oftentimes, it's cancer patients really at any stage who wish to reduce the number of medications that they're on, who wish to try something different. Some of my patients are really frustrated with standard pharmaceutical drugs. And they wish to have a greater sense of control over how they dose their own medications – and that's the most common reason why patients come to our practice with questions regarding cannabis.

Also, a minority of my patients, through a variety of channels might have heard that it could treat the cancer itself as a kind of chemo therapeutic. And it's really for – we interpret that as a statement of faith that, you know, this is a life and death kind of situation for me, why not try something that might help me. And in those situations, we are frank with the evidence that there is no clinical data, that it does help extend the lives of people living with cancer, it's not a cancer treatment, per se. And we find that question and opportunity to really explore hopes, goals, values, by way of that question about cannabis, as a potential treatment for their illness.

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An expert discusses the most common reasons his patients ask him about medical marijuana.

Common Questions on Medical Marijuana

Patients with blood cancer may not get the same protection from COVID-19 vaccination as the general population, as a recent study found that about one in four patients did not have detectable antibodies after getting the vaccine.

“While the vaccines were tested in the healthy population, they were approved based on safety, the ability to make an antibody against the virus that causes COVID-19 and protection against serious COVID-19 infection,” Dr. Gwen Nichols, chief medical officer of The Leukemia & Lymphoma Society (LLS) said in an interview with CURE®.

Vaccine Effectiveness Analyzed in Blood Cancer Survivors

Nichols was involved in research conducted by the LLS that involved 1,445 patients with blood cancer who had antibodies – which the body develops after vaccination to fight off the virus that causes COVID-19 – measured at least two weeks after receiving their second dose of the Moderna or Pfizer mRNA vaccine.

The study was important for a couple of reasons. First, the clinical trials investigating the COVID-19 vaccines excluded patients with cancer, citing safety concerns, and second, people with blood cancer tend to have a higher rate of serious infection and death after being diagnosed with COVID-19.

“Almost everyone (in the study) made antibodies and almost all were protected. However, some blood cancer patients and other immunosuppressed patients don’t make the antibody to help fight the virus. While there still may be some protection through vaccination, people who don’t make antibodies may be at greater risk of ‘breakthrough’ infection, even after being fully vaccinated,” Nichols said.

The likelihood of having COVID-19 antibodies after vaccination varied by blood cancer type, according to the study findings.

Patients with non-Hodgkin lymphoma (NHL) were the least likely to have detectable antibodies, with seronegativity (meaning that no detectable amounts of the virus/antibodies were found) ranging by NHL subtype – from 21% of patients with diffuse large B-cell lymphoma being seronegative, compared to 56% of those with mantle cell lymphoma.

“There is no definitive way to know without testing, but patients who have B-cell malignancies, such as non-Hodgkin lymphoma and chronic lymphocytic leukemia appear to be at higher risk,” Nichols said. “Also … recent use of therapies which suppress the B-lymphocytes – anti-CD20 antibody therapies, Bruton tyrosine kinase (BTK) inhibitors and others – may put patients at higher risk.”

These drugs impair B-cells that make antibodies. Similarly, more than a third (36%) of patients with chronic lymphocytic leukemia (CLL) were seronegative, although 30% reported not having cancer treatment within the last two years. This points toward the potential of the actual disease inhibiting B cell functioning. Patients with CLL who 

 treated within the last few years had even higher rates of seronegativity.

CAR-T cell therapy may also affect vaccine response, as six out of seven patients with diffuse large B-cell lymphoma or follicular lymphoma were seronegative after being vaccinated. Again, this is likely due to the inhibition of normal B cells. Although, 80% of patients with myeloma who received a different type of CAR-T cell therapy produced antibodies.

Of all the blood cancer types, multiple myeloma had the lowest rate (5%) of seronegativity, meaning that patients with multiple myeloma were most likely to develop antibodies from the vaccine.

Despite these findings, Nichols encourages patients with blood cancer to get the COVID-19 vaccine, as the safety profile in the patients surveyed was similar to that in the rest of the population.

“Patients should definitely get vaccinated, unless their physician tells them they have a medical reason not to,” she said. “Antibodies may not be the only way the vaccine protects us from COVID-19.”

If patients suspect that they’ve been exposed to COVID-19, they should tell their health care team immediately. Nichols also advocated for patients to continue to social distance, wear masks and avoid crowded, poorly ventilated spaces, even after getting their vaccine.

“Get vaccinated, act unvaccinated,” she said.

About 25% of patients with blood cancer did not produce antibodies after being vaccinated against COVID-19.

Brielle Benyon

Pain Management Has Worsened for Patients With Late-Stage Cancer

FDA Approves Keytruda/Chemo for Triple-Negative Breast Cancer

Common Questions on Medical Marijuana

Patients With Blood Cancer Less Likely to Produce COVID-19 Antibodies After Vaccination

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