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In Reply We thank Dr Meghani for her thoughtful reply to our Editorial about the recent Centers for Disease Control and Prevention (CDC) guideline on opioid prescribing1 and its application to cancer survivors. While Dr Meghani takes exception to our position that the CDC guideline statement excluded the context of cancer care, she agrees that the points made in our Editorial are relevant and timely for cancer survivors. It is important to acknowledge the complexities involved in the transition from active cancer treatment into the world of primary care. The Institute of Medicine report from 2006 addressing this transition to cancer survivorship identified 4 essential components to survivorship care, including not only aspects of cancer prevention and surveillance, but also interventions to treat the consequences of cancer and its treatment, as well as coordination of care between specialists and primary care clinicians.2(p188) A thorny issue arises from the heterogeneity among models of survivorship care,3 and in the timing of the transition of care to nononcology clinicians. Not all patients and their oncology specialists embrace the transition to primary care settings or shared care, and not all primary care clinicians are comfortable caring for cancer survivors requiring complex care.4 Thus, while the CDC guideline related to chronic pain did not explicitly exclude cancer patients beyond active treatment, it clearly did not attempt to address the complicated issues of posttreatment cancer survivorship, nor were cancer specialists or palliative care specialists featured on the expert panel.
Fisch MJ, Chang VT. Intended Target of the Centers for Disease Control and Prevention Opioid Guidelines—Reply. JAMA Oncol. 2016;2(9):1243–1244. doi:10.1001/jamaoncol.2016.2184
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