Background/Objectives: Insomnia is a frequent and distressing symptom with limited treatment in patients with cancer. Among the available treatments for insomnia, psychological interventions are some of the most assessed. While studies and reviews show promise of interventions improving insomnia in patients with cancer, inconsistent approaches to operationalizing and measuring insomnia combined with the heterogeneity of available treatments render comparisons and synthetization difficult. This review sought to rigorously synthesize psychological interventions for patients with cancer and insomnia by describing current therapies, identifying gaps in the literature, and offering supportive interventions. Methods: A comprehensive search of five databases—Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, EBSCO CINAHL Plus with Full Text, and Cochrane Library—was conducted through 1 August 2024. The review included randomized trials and non-inferiority trials evaluating psychological interventions for patients with various types of cancers. Twenty-one studies were included, and study quality ranged from good to excellent, according to the PEDro scale. Results: The current evidence supports the use of cognitive behavioral therapy (CBT) to treat insomnia over and above psychoeducation alone, mindfulness-based stress reduction, Brief Behavioral Therapy, the Benson Relaxation Technique, progressive muscle relaxation, mindfulness meditation, mind-body bridging, and home-based psychological nursing. Digital, minimal, and internet-based intervention modalities are effective, though professional-delivered CBT proved most effective. Conclusions: CBT remains the most effective psychological intervention for insomnia in this population. Challenges exist regarding the implementation of CBT, so further research is warranted to identify the best psychological interventions for specific settings and subsets of patients with cancer.

Objective: A knowledge gap persists regarding how patients with cancer requiring opioids and their caregivers perceive a co-prescription of naloxone. This study aims to understand caregivers of cancer patients’ perceptions, beliefs, knowledge, and confidence regarding naloxone. Methods: This prospective cross-sectional survey study was conducted at an outpatient palliative and supportive care clinic in a tertiary cancer center in the US between May 2020 and April 2022. Survey questions were based on an in-depth review of previous literature and opioid studies. Patients at risk for opioid overdose received naloxone prescriptions from our team. The survey study examined the proportion of caregivers who perceived a prescription of naloxone benefits the cancer patient and assessed the association between the patients’ and caregivers’ perceptions. We collected patient demographics and clinical information data. The survey was administered via telephone interview based on the caregivers’ availability. Results: A total of 150 cancer patients and 29 caregivers were included in the analysis. A total of 100/150 (67%) patients and 23/29 (79%) caregivers perceived naloxone as beneficial. Cohen’s κ showed fair agreement between the patients and their caregivers (Cohen’s κ = 0.34, p = 0.034). A total of 26/29 (89.7%) caregivers felt confident in administering naloxone and calling for help. A total of 29/29 (100%) caregivers agreed that concurrent use of alcohol with pain medications increases risk of overdose. Significance of results: Cancer patients and caregivers perceived naloxone as beneficial and not likely to cause harm. Agreement between patients and caregivers was only fair, suggesting that better communication regarding naloxone is needed. More research is needed to identify barriers toward safe opioid prescription and increase awareness toward naloxone.

Objectives: Parents navigating a cancer diagnosis are at risk for higher levels of distress and have reported needs including communicating a cancer diagnosis to their young children and preparing them for transition to end-of-life care. There have been few empirically validated interventions in the literature to address this unique population and their needs. Ensuring Children Have Optimal Support (ECHOS) program was developed in our tertiary cancer center to support entire families using strategies from evidence-based psychosocial and family-centered interventions. The program helps patients with cancer and their families communicate about the diagnosis with their children and promote family well-being. Methods: A case study is presented to illustrate the specific needs of a cancer patient with children and demonstrate clinical interventions provided through our ECHOS program. Results: Specific parental needs addressed included communication of diagnosis, preparation for death, and supporting anticipatory grief. Significance of results: Our case study illustrates specific needs that cancer patients with children face. We recommend screening and family-tailored interventions for all cancer patients with minor children.

Importance: Urine drug test (UDT) can help screen and monitor aberrant controlled substance use among patients requiring opioid therapy for cancer pain. However, data on UDT utilization in patients with cancer pain remains limited. Objective: To determine the rate of UDT ordering and the factors associated with UDT order placement and the frequency and type of abnormal UDT findings. Methods: This retrospective study included adults (≥18 yrs) with a cancer diagnosis receiving prescription opioids for pain in an ambulatory pain clinic from November 2017 through April 2018. Descriptive statistics summarized patient characteristics and UDT findings. Logistic regression was used to identify factors associated with UDT ordering. Results: Five hundred fifty-eight patients were included in the study; the median age was 61 years, 52% were female, 74% were White, and 93% had active cancer. One hundred forty-one patients (25%) had UDT orders. On multivariate analysis, UDT ordering was associated with SOAPP-14 score ≥ 7 (OR, 2.03 95% CI 1.19–3.47 p = 0.009) and a history of substance use disorder (OR, 2.87 95% CI: 1.39–5.75 p = 0.004). Among those tested, 49 (35%) had abnormal results. A total of 80 abnormalities were identified, with some UDTs showing multiple findings; the most common was the absence of prescribed opioids (48%). Conclusions: Only one in four patients receiving opioids in an ambulatory cancer pain clinic received a UDT order, suggesting a more selective rather than routine use. UDT ordering was more common among patients with a SOAPP-14 score ≥ 7 and a history of substance use disorder. Among patients who underwent UDT, approximately one-third had abnormal results, with the absence of prescribed opioids or their expected metabolites being the most common finding. These findings suggest that UDT may provide important clinically relevant information as a component of comprehensive opioid monitoring. Further research is needed to establish evidence-based approaches to UDT implementation that promote consistent opioid safety practices.