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Grant Details

Grant Number: 5R21CA198172-02 Interpret this number
Primary Investigator: Lapane, Kate
Organization: Univ Of Massachusetts Med Sch Worcester
Project Title: Opioids and Adjuvants for Pain in Nursing Home Residents with Cancer
Fiscal Year: 2016


¿ DESCRIPTION (provided by applicant): Nearly 1/3rd of Medicare beneficiaries with cancer will receive care in a nursing home (NH). Our preliminary work revealed that among NH residents with cancer, 28.3% had daily pain with 13.5% experiencing severe pain and 61.3% with moderate pain. Opioid use was common for those with daily pain, despite the potential for significant adverse effects such as insomnia, depression, constipation and cognitive impairment. The extent to which adjuvants to analgesia may be used to improve the level of analgesia and ultimately reduce opioid dosage has not been explored in this vulnerable population. The proposed work uses a contemporaneous dataset to provide longitudinal descriptions of the management of pain in newly admitted NH residents with cancer. We propose merging elements of the following existing databases: the Minimum Data Set (MDS), Medicare eligibility and claims data (Part A, B & D), and the Certification and Survey Provider Enhanced Reporting (CASPER) system. Using state of the art analytic methods such as marginal structural models, the specific aims are to: 1) Describe the pattern of analgesic use in terms of "morphine equivalents", route of administration, and use of adjuvants to analgesia in patients newly admitted to NHs with cancer and to compare the level of daily pain, analgesia use, and adjuvant use as a function of age, gender, race/ethnicity and level of cognitive impairment.; 2) Evaluate the extent to which pharmacologic management of pain including the uptake of adjuvants to analgesia intensifies over time in NH residents with cancer; and 3) Quantify the association between adjuvants to pain medication and reduction of opioid dose and potential adverse effects (e.g. constipation). The National Cancer Institute is interested in pursuing clinical research to evaluate the role of adjuvants to chronic pain management (PA-14-225). The proposed exploratory work is a necessary precursor prior to design of an RO1 for the NH context. No studies have attempted to characterize the longitudinal experience of pain and use of opioids and adjuvants in NH residents with cancer. Evaluation of the changes in pain, pharmacologic pain treatments, use of adjuvants and outcomes in a contemporaneous national dataset of NH residents with cancer will form the basis of a scientifically sound larger randomized controlled experiment of the use of adjuvants in pain management in NH settings.


Racial/Ethnic Differences in Staff-Assessed Pain Behaviors Among Newly Admitted Nursing Home Residents.
Authors: Morrison R. , Jesdale B. , Dube C. , Forrester S. , Nunes A. , Bova C. , Lapane K.L. .
Source: Journal of pain and symptom management, 2021 Mar; 61(3), p. 438-448.e3.
EPub date: 2020-08-31.
PMID: 32882357
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Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition.
Authors: Jesdale B.M. , Mack D.S. , Forrester S.N. , Lapane K.L. .
Source: Journal of the American Medical Directors Association, 2020 Sep; 21(9), p. 1302-1308.e7.
EPub date: 2020-03-26.
PMID: 32224259
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Adjuvant Use and the Intensification of Pharmacologic Management for Pain in Nursing Home Residents with Cancer: Data from a US National Database.
Authors: Liu S.H. , Hunnicutt J.N. , Ulbricht C.M. , Dubé C.E. , Hume A.L. , Lapane K.L. .
Source: Drugs & aging, 2019 Jun; 36(6), p. 549-557.
PMID: 30924097
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Missing Data in Marginal Structural Models: A Plasmode Simulation Study Comparing Multiple Imputation and Inverse Probability Weighting.
Authors: Liu S.H. , Chrysanthopoulou S.A. , Chang Q. , Hunnicutt J.N. , Lapane K.L. .
Source: Medical care, 2019 Mar; 57(3), p. 237-243.
PMID: 30664611
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Screening mammography among nursing home residents in the United States: Current guidelines and practice.
Authors: Mack D.S. , Epstein M.M. , Dubé C. , Clark R.E. , Lapane K.L. .
Source: Journal of geriatric oncology, 2018 Nov; 9(6), p. 626-634.
EPub date: 2018-06-04.
PMID: 29875079
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The Impact of Nondifferential Exposure Misclassification on the Performance of Propensity Scores for Continuous and Binary Outcomes: A Simulation Study.
Authors: Wood M.E. , Chrysanthopoulou S. , Nordeng H.M.E. , Lapane K.L. .
Source: Medical care, 2018 Aug; 56(8), p. e46-e53.
PMID: 28922298
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Cognitive Impairment and Pain Among Nursing Home Residents With Cancer.
Authors: Dubé C.E. , Mack D.S. , Hunnicutt J.N. , Lapane K.L. .
Source: Journal of pain and symptom management, 2018 Jun; 55(6), p. 1509-1518.
EPub date: 2018-02-26.
PMID: 29496536
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Non-Hispanic Black-White disparities in pain and pain management among newly admitted nursing home residents with cancer.
Authors: Mack D.S. , Hunnicutt J.N. , Jesdale B.M. , Lapane K.L. .
Source: Journal of pain research, 2018; 11, p. 753-761.
EPub date: 2018-04-12.
PMID: 29695927
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Pain and pharmacologic pain management in long-stay nursing home residents.
Authors: Hunnicutt J.N. , Ulbricht C.M. , Tjia J. , Lapane K.L. .
Source: Pain, 2017 Jun; 158(6), p. 1091-1099.
PMID: 28267065
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Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer.
Authors: Hunnicutt J.N. , Tjia J. , Lapane K.L. .
Source: Journal of pain and symptom management, 2017 Mar; 53(3), p. 561-570.
EPub date: 2016-12-29.
PMID: 28042063
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Probabilistic bias analysis in pharmacoepidemiology and comparative effectiveness research: a systematic review.
Authors: Hunnicutt J.N. , Ulbricht C.M. , Chrysanthopoulou S.A. , Lapane K.L. .
Source: Pharmacoepidemiology and drug safety, 2016 Dec; 25(12), p. 1343-1353.
EPub date: 2016-09-05.
PMID: 27593968
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New Initiation of Long-Acting Opioids in Long-Stay Nursing Home Residents.
Authors: Pimentel C.B. , Gurwitz J.H. , Tjia J. , Hume A.L. , Lapane K.L. .
Source: Journal of the American Geriatrics Society, 2016 Sep; 64(9), p. 1772-8.
EPub date: 2016-08-03.
PMID: 27487158
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Implementation and reporting of causal mediation analysis in 2015: a systematic review in epidemiological studies.
Authors: Liu S.H. , Ulbricht C.M. , Chrysanthopoulou S.A. , Lapane K.L. .
Source: BMC research notes, 2016-07-20; 9, p. 354.
EPub date: 2016-07-20.
PMID: 27439301
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Commentary: Osteoarthritis and Mortality: Answering Questions or Questioning Answers?
Authors: Lapane K.L. , Liu S.H. .
Source: Epidemiology (Cambridge, Mass.), 2016 Jul; 27(4), p. 477-8.
PMID: 26986873
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Plus ça change, plus c'est la même chose [The More Things Change, the More They Stay the Same].
Authors: Lapane K.L. .
Source: Medical care, 2015 Dec; 53(12), p. 998-9.
PMID: 26569641
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