Tom Baker Cancer Centre, Calgary, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2019 Jul;58(1):100-107.e2. doi: 10.1016/j.jpainsymman.2019.02.024. Epub 2019 Mar 2.
To evaluate factors associated with opioid use in patients with cancer surviving more than five years without recurrence. We evaluated exposures of opioid use before cancer diagnosis, opioid use between cancer diagnosis and five-year anniversary, surgeries, and chemotherapy.
We conducted a retrospective cohort study using linked provincial administrative data. Patients were aged 24-70 years and eligible for government-funded pharmacare. The index date was the five-year anniversary from diagnosis. Patients were accrued between 2010 and 2015. The main outcome was opioid prescription rate after index date. The main exposures were opioid use before diagnosis, opioid use between diagnosis and index, surgeries, and chemotherapy. A negative binomial regression model was used to estimate relative rates (RR) of opioid use after index date.
Our cohort included 7431 individuals. The overall crude prescription rate after the index date was 2 per person-year. The factor most strongly associated with a higher rate of opioid use after index was continuous opioid use between diagnosis and index (RR 46.1, 95% confidence interval 34.8-61.2). Opioid use before diagnosis was also a factor (RR = 1.8, 95% confidence interval 1.44-2.19). A history of depression, comorbidity, and more than two years of diabetes were also associated with higher risk of post-index date opioid use. Significant interactions were identified between prior opioid use and opioid use between diagnosis and index. Most prescriptions are from family physicians.
Patients who use opioids continuously between diagnosis and index date are at increased risk of continued use after five years of survival. Safe and appropriate pain management is an important survivorship issue.
评估与癌症存活五年以上且无复发的患者使用阿片类药物相关的因素。我们评估了癌症诊断前、诊断至五年纪念日期间、手术和化疗期间使用阿片类药物的情况。
我们使用链接的省级行政数据进行了回顾性队列研究。患者年龄在 24-70 岁之间，有资格享受政府资助的药物福利计划。索引日期为诊断后的五年纪念日。患者在 2010 年至 2015 年期间被招募。主要结局是索引日期后开具阿片类药物处方的比例。主要暴露因素是诊断前使用阿片类药物、诊断至索引日期期间使用阿片类药物、手术和化疗。使用负二项回归模型估计索引日期后使用阿片类药物的相对比率（RR）。
我们的队列包括 7431 人。索引日期后总体粗处方率为每人每年 2 次。与索引日期后阿片类药物使用率较高最相关的因素是诊断至索引日期期间持续使用阿片类药物（RR 46.1，95%置信区间 34.8-61.2）。诊断前使用阿片类药物也是一个因素（RR=1.8，95%置信区间 1.44-2.19）。抑郁症病史、合并症和糖尿病超过两年也与索引日期后使用阿片类药物的风险增加相关。在诊断前使用阿片类药物和诊断至索引日期期间使用阿片类药物之间发现了显著的交互作用。大多数处方来自家庭医生。
在诊断至索引日期期间持续使用阿片类药物的患者在五年生存后继续使用的风险增加。安全和适当的疼痛管理是一个重要的生存问题。
