Cancer-related pain affects a majority of patients with advanced cancer and is often undertreated. The treatment of this pain is largely reliant on the use of opioids, which are essential medicines for symptom management and the maintenance of quality of life (QoL) for patients with advanced cancer. While there are cancer-specific guidelines for the treatment of pain, widespread publication and policy changes in response to the opioid epidemic have drastically impacted perceptions of opioid use. This overview therefore aims to investigate how manifestations of opioid stigma impact pain management in cancer settings, with an emphasis on the experiences of patients with advanced cancer. Opioid use has been widely stigmatized in multiple domains, including public, healthcare, and patient populations. Physician hesitancy in prescribing and pharmacist vigilance in dispensing were identified as barriers to optimal pain management, and may contribute to stigma in the context of advanced cancer. Evidence in the literature suggests that opioid stigma may result in patient deviations from prescription instructions, which generally leads to pain undertreatment. Patients reflected on experiencing shame and fear surrounding their prescription opioid use and feeling uncomfortable communicating with their healthcare providers on these topics. Our findings indicate that future work is required to educate patients and providers in order to de-stigmatize opioid use. Through alleviating stigma, patients may be better able to make decisions regarding their pain management which lead to freedom from cancer-related pain and improved QoL.

The objectives of this study were to systematically identify studies that (i) quantified the prevalence of breast cancer screening among female survivors of a prior cancer other than breast cancer and (ii) compared the likelihood of undergoing breast cancer screening between cancer survivors and cancer-free controls. Effect estimates were pooled using random-effects meta-analyses. Stratified analyses were performed across primary cancer sites with three or more studies. Sixty-two studies were included in this review. The prevalence of breast cancer screening among female cancer survivors was 0.67 [95% confidence interval (CI), 0.62–0.71], ranging from 0.49 (lung) to 0.75 (cervical) across primary cancer sites. The prevalence of breast cancer screening was higher among studies that ascertained screening through self-report and studies conducted in North America. The odds of undergoing breast cancer screening were significantly greater among cancer survivors compared with cancer-free controls (odds ratio: 1.24; 95% CI, 1.13–1.36). Although cancer survivors had higher rates of breast cancer screening compared with cancer-free controls, overall rates were below population-based screening targets. Given that cancer survivors are at an elevated risk of subsequent breast cancer, future studies should evaluate predictors of screening nonadherence and explore targeted approaches to improve participation in breast cancer screening among cancer survivors.

Supplementary Figure 1. Forest plot of prevalence of breast cancer screening among cancer survivors. The estimated prevalence of breast cancer screening for each study is presented numerically and graphically, with point estimates shown as boxes scaled by study weight and whiskers representing the 95% confidence intervals (CIs). The overall pooled prevalence, calculated using a random-effects model, is represented by a diamond, with its width corresponding to the 95% CI.

Supplementary Table 1. Database search strategy for this systematic review.