PROJECT SUMMARY/ABSTRACT Advances in cancer diagnosis and treatment have allowed individuals with cancer to survive their disease at high rates. However, survivorship is often accompanied by challenging long-term sequelae such as chronic cancer pain. Though prescription opioids are often prescribed during active treatment, the role of prescription opioids in chronic cancer pain management is less clear. There is little literature as to the safety and efficacy of opioids in this population, so survivors and their clinicians are stuck between two worlds – cancer pain, in which opioids are standard of care, and chronic pain, in which long-term opioids are known to carry significant risk including opioid misuse, addiction, and death. This challenge is particularly impactful in the mist of the opioid epidemic, in which negative public attitudes towards prescription opioids are prevalent. As a result, cancer survivors with chronic pain may be at particularly high risk for stigmatization, a detrimental phenomenon associated with adverse health outcomes (e.g., emotional distress, suboptimal health behaviors and coping strategies, difficult patient-provider communication). We posit that prescription opioid use and chronic pain are two important sources of intersecting stigma in cancer patients. Prescription opioid stigma and chronic pain stigma have been explored separately in other patient groups; however, there is little literature that directly explores these intersecting stigmas in cancer survivors. As the population of cancer survivors on long-term opioid therapy continues to increase, understanding stigma experiences in this group is a time-sensitive, critical need. Consistent with the NIH Helping to End Addiction Long-term (HEAL) initiative’s key priority of enhancing pain management, the aim of this proposal is to obtain a comprehensive understanding of co-occurring prescription opioid and chronic pain stigmas in cancer survivors with chronic pain. The results of this study will support the development of a future multi-level behavioral intervention to mitigate the impact of stigma and improve pain management in this population. Guided by the Health Stigma and Discrimination Framework, we will conduct in-depth qualitative interviews exploring prescription opioid and chronic pain stigma in 20 cancer survivors with moderate-to-severe pain, 20 caregivers, and 20 clinicians who treat patients with chronic cancer pain, including oncologists, primary care providers, pain management specialists, and palliative care physicians. We will conduct thematic analysis to identify potential contributors to stigma in cancer survivors, with an emphasis on potential targets of future interventions, and explore proximal and long-term health outcomes. This proposal is innovative and timely, as we are among the first to advance a comprehensive understanding of intersecting prescription opioid and chronic pain stigma in cancer survivors. We will use this evidence to develop a comprehensive, multi-level behavioral intervention to reduce these stigmas and improve patient outcomes, including pain management and quality of life. This proposal is significant because our research has the potential to promote safe, effective, and informed opioid pain management practices in millions of cancer survivors living with chronic pain

PROJECT NARRATIVE This proposal addresses two stigmatizing public health problems that arise in the care of cancer survivors: (1) chronic pain, which is present in up to 40% of cancer survivors, and (2) use of prescription opioid medications, which are considered standard of care for moderate-to-severe cancer pain management. The purpose of this proposal is to obtain a comprehensive understanding of intersecting prescription opioid and chronic pain stigmas in cancer survivors with chronic pain, which will be used to support the development of multi-level intervention to mitigate the negative consequences of stigma. By understanding and intervening on stigma in cancer survivors, our research has the potential to promote safe, effective, and informed opioid pain management practices in millions of cancer survivors living with chronic pain; therefore, this proposal is responsive to the NIH Helping to End Addiction Long-term (HEAL) initiative’s key priority of enhancing pain management.