18-64 岁癌症和非癌症患者阿片类药物处方比较：基于行政数据的分析。

Comparison of Opioid Prescribing Among Cancer and Noncancer Patients Aged 18-64: Analysis Using Administrative Data.

机构信息

Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.

出版信息

J Pain Symptom Manage. 2018 Jul;56(1):72-79. doi: 10.1016/j.jpainsymman.2018.03.010. Epub 2018 Mar 14.

DOI:10.1016/j.jpainsymman.2018.03.010

PMID:29548892

Abstract

BACKGROUND

Opioid prescribing has been increasingly scrutinized among noncancer patients. As an unintended consequence, opioids may be underprescribed for cancer patients. The purpose of this study was to compare trends in opioid prescribing in younger adults with and without cancer.

METHODS

From 2004 to 2013, Ontario residents aged 18-64 years eligible for government paid pharmacare were annually stratified into three groups: no cancer history, cancer diagnosis more than five years ago, and cancer diagnosis five years ago and less. We evaluated time trends in two annual outcomes: opioid prescription rate and mean daily opioid dose.

RESULTS

In 2013, 800,371 individuals were eligible for this study (3% with recent cancer and 2% with remote cancer). Across all years, compared with noncancer patients, overall opioid prescription rates were 43% and 26% higher for those with recent and remote cancer, respectively. Overall, a 1% relative annual increase was seen in those without cancer and a 1% decrease was seen in those with a recent cancer. Changes in prescription rates varied with drug class and cancer group. Notably, long-acting opioids had a relative annual increase of 7% in noncancer patients vs. 2% in recent cancer patients. Immediate-release combination agents had a relative annual decrease of 2% for all cancer groups. Trends in mean daily dose were similar between groups, but by 2013, they were lowest in recent cancer patients, regardless of drug class.

INTERPRETATION

Secular trends in opioid prescribing affect cancer and noncancer patients similarly. Further research is required to assess the potential impact on symptom management.

摘要

背景

非癌症患者的阿片类药物处方越来越受到严格审查。作为一个意想不到的结果，癌症患者的阿片类药物可能开得不足。本研究的目的是比较有和无癌症的年轻成年人阿片类药物处方的趋势。

方法

从 2004 年到 2013 年，安大略省有资格获得政府付费处方药的 18-64 岁居民每年分为三组：无癌症史、癌症诊断超过五年和癌症诊断五年及以下。我们评估了两个年度结果的时间趋势：阿片类药物处方率和平均每日阿片类药物剂量。

结果

在 2013 年，有 800371 人符合本研究的条件（最近癌症患者占 3%，远处癌症患者占 2%）。在所有年份中，与非癌症患者相比，最近和远处癌症患者的总体阿片类药物处方率分别高 43%和 26%。总体而言，非癌症患者的相对年增长率为 1%，而最近癌症患者的相对年增长率为 1%。处方率的变化随药物类别和癌症组而异。值得注意的是，长效阿片类药物在非癌症患者中的相对年增长率为 7%，而在最近癌症患者中为 2%。所有癌症组的即时释放组合剂的相对年增长率为 2%。两组之间的平均每日剂量趋势相似，但到 2013 年，无论药物类别如何，最近癌症患者的剂量最低。