Decreasing Long-term Opioid Use in Cancer Survivors

This is a feasibility pilot trial assessing a behavioral intervention for chronic pain among disease-free cancer survivors to decrease long-term opioid dependence.

To assess the feasibility and acceptability of implementing brief Acceptance and Commitment Therapy for chronic pain (ACT-CP) in a Survivorship clinic.

Delivered virtually via Zoom or via telephone on an individual level; 30-minute sessions led by a trained psychologist and occur weekly for 6 weeks.

Study feasibility will be assessed by tracking the number of participants that consent to enroll in the trial.

Study feasibility will be assessed by recruitment yield, i.e., tracking the number of participants who initiated treatment.

Study feasibility will be assessed by tracking the number of participants attend each intervention session over the course of the 6-week intervention period.

Study acceptability will be assessed by administering a post-intervention satisfaction survey which asks about satisfaction with the program including perceived efficacy and suggestions for improvement.

Preliminary efficacy of acceptance and commitment therapy for chronic pain (ACT-CP) will be assessed by analyzing change in self-reported pain scores using The Patient-Reported Outcome Measurement Information System short form 3a v1.0 (PROMIS). This tool measures how much a person hurts.

Preliminary efficacy of acceptance and commitment therapy for chronic pain (ACT-CP) will be assessed by self-reported opioid use frequency weekly throughout the intervention period.

Preliminary efficacy of acceptance and commitment therapy for chronic pain (ACT-CP) will be assessed by analyzing pain interference using the PROMIS short form 8a. The PROMIS Pain Interference instrument measures the self-reported consequences of pain on relevant aspects of a person's life and may include the extent to which pain hinders engagement with social, cognitive, emotional, physical, and recreational activities.

Inclusion Criteria: Diagnosis of cancer of any type, currently in remission, having completed active primary therapy. Patients on oral adjuvant hormone therapy will still be eligible. Completed active therapy must have been curative in intent (for example stage IV cancer patients such as head and neck cancer patients treated with curative intent are eligible). Self-reported cancer pain for >= 3 months Opioid use >= 5MME/day (morphine milligram equivalents) as prescribed by physician for cancer-related pain for at least 6 months beyond completion of their cancer treatment VCUHealth system patient Exclusion Criteria: History of opioid use prior to cancer diagnosis Anyone with prior history of substance use disorder or currently enrolled in a methadone program Anyone with schizophrenia or bipolar disorder Current utilization of psychotherapy services for pain, depression, anxiety, and/or PTSD Cognitive concerns that would prevent meaningful engagement in treatment Inability to converse in English Lack of working telephone and Internet connection (must have at least one or the other) Anyone found to have progression of cancer Anyone diagnosed with cancer recurrence or new cancer during their study period Documented diagnosis of or positive screen for current substance use disorder (score >5 on the Drug Abuse Screening Test-10 [DAST-10]) Anyone scoring >=8 on ORT indicating very high risk for opioid abuse