Hall Susannah, Gallagher Rollin M, Gracely Edward, Knowlton Calvin, Wescules Douglas
excelleRx Institute, Philadelphia, Pennsylvania 19106, USA.
Pain Med. 2003 Jun;4(2):125-34. doi: 10.1046/j.1526-4637.2003.03020.x.
The objective of the current study is to describe correlations between age, gender, and primary cancer site and sustained-release opioid doses prescribed for hospice patients at the end of life.
This study included all 7,201 hospice patients referred to a North American palliative care specialty pharmacy with the primary diagnosis of cancer and who were prescribed transdermal fentanyl, sustained-release oral morphine, or sustained-release oxycodone.
This is a retrospective analysis of the final sustained-release morphine, oxycodone, or transdermal fentanyl doses prescribed to cancer patients, according to pharmacy records. Comparisons between sex and age group were performed with chi-square tests. Mann-Whitney U tests were used to compare mean doses between the sexes. Analyses of covariance (ANCOVA) were used to compare opioid doses between genders and among primary cancer sites while controlling for age.
The inverse association between age group and dose was highly significant. For example, final opioid doses </=120 mg/day oral morphine equivalent were prescribed for only 46.4% of patients between 40 and 49 years of age compared with 86.4% of patients 90 years of age and older. An ANCOVA on the largest non-sex-related diagnoses found primary tumor site and patient age, but not gender, to be associated with sustained-release opioid dose.
Both primary tumor site and patient age were associated with final opioid dose. Further investigation is warranted to determine which primary tumor sites are associated with unusually high opioid doses and may highlight the need to optimize adjuvant medication therapy if neuropathic and/or inflammatory pain mechanisms are involved and to refer to pain specialists when appropriate.
本研究的目的是描述年龄、性别、原发癌部位与临终关怀患者开具的缓释阿片类药物剂量之间的相关性。
本研究纳入了所有7201名转诊至北美一家姑息治疗专科药房的临终关怀患者，这些患者的主要诊断为癌症，且开具了透皮芬太尼、缓释口服吗啡或缓释羟考酮。
这是一项根据药房记录对开具给癌症患者的最终缓释吗啡、羟考酮或透皮芬太尼剂量进行的回顾性分析。采用卡方检验对性别和年龄组之间进行比较。使用曼-惠特尼U检验比较两性之间的平均剂量。在控制年龄的同时，采用协方差分析（ANCOVA）比较不同性别和原发癌部位之间的阿片类药物剂量。
年龄组与剂量之间的负相关非常显著。例如，40至49岁的患者中，最终阿片类药物剂量≤120毫克/天口服吗啡当量的患者仅占46.4%，而90岁及以上的患者中这一比例为86.4%。对最大的非性别相关诊断进行的协方差分析发现，原发肿瘤部位和患者年龄与缓释阿片类药物剂量相关，而性别无关。
原发肿瘤部位和患者年龄均与最终阿片类药物剂量相关。有必要进一步调查哪些原发肿瘤部位与异常高的阿片类药物剂量相关，如果涉及神经病理性和/或炎症性疼痛机制，可能凸显优化辅助药物治疗的必要性，并在适当的时候转诊至疼痛专科医生处。
