癌症患者在姑息治疗门诊就诊时同时使用阿片类药物与苯二氮䓬类或非苯二氮䓬类镇静剂。

Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic.

机构信息

Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.

出版信息

Cancer. 2019 Dec 15;125(24):4525-4531. doi: 10.1002/cncr.32484. Epub 2019 Aug 28.

DOI:10.1002/cncr.32484

PMID:31460669

Abstract

BACKGROUND

The concurrent use of opioids with benzodiazepines (BZD) or nonbenzodiazepine sedatives (S) recently was found to be associated with an increased risk of overdose death compared with the use of opioids alone. In the current study, the authors examined the frequency and trend of concurrent opioid/BZD-S use and its associated risk factors among patients with cancer.

METHODS

Data regarding the frequency and trend of concurrent opioid/BZD-S use were extracted for 1500 randomly selected patients referred to the outpatient palliative care clinic at The University of Texas MD Anderson Cancer Center between the calendar years of 2011 and 2016. To explore associated risk factors, the authors compared the demographic and clinical predictors of 418 patients each in the concurrent opioid/BZD-S group and opioids-only group.

RESULTS

In 2011, at the time of referral to the palliative care clinic, 96 of 221 patients with cancer (43%) were prescribed concurrent opioids/BZD-S. This rate progressively declined to 67 of 217 patients (31%) by 2016 (P = .0008). Patients in the concurrent opioid/BZD-S group had a higher percentage of females (233 individuals; 55% [P = .007]) and whites (323 individuals; 77% [P = .002]), and patients reported higher scores regarding depression (P = .0001), anxiety (P ≤ .0001), drowsiness (P = .048), and worst feeling of well-being (P = .001). The morphine equivalent daily dose was significantly higher in concurrent opioid/BZD-S group (median of 67.5 mg/day [interquartile range (IQR), 30-135 mg/day] vs 60 mg/day [IQR, 30-105 mg/day]; P = .034). Multivariate analysis demonstrated that anxiety (P ≤ .0001), white race (P = .0092), and poor Eastern Cooperative Oncology Group performance status (P = .0017) were significantly associated with concurrent use.

CONCLUSIONS

The concurrent use of opioids with BZD-S has declined but continues to be frequent among patients with cancer. Anxiety, white race, and poor Eastern Cooperative Oncology Group performance status were associated with its use. More research is needed to explore which medications can replace these agents.

摘要

背景

最近发现，与单独使用阿片类药物相比，同时使用阿片类药物与苯二氮䓬类药物（BZD）或非苯二氮䓬类镇静剂（S）会增加过量死亡的风险。在本研究中，作者检查了癌症患者中同时使用阿片类药物/BZD-S 的频率和趋势及其相关危险因素。

方法

从 2011 年至 2016 年，从德克萨斯大学 MD 安德森癌症中心门诊姑息治疗诊所随机抽取 1500 名患者，提取同时使用阿片类药物/BZD-S 的频率和趋势数据。为了探讨相关危险因素，作者比较了同时使用阿片类药物/BZD-S 组和仅使用阿片类药物组中每组 418 名患者的人口统计学和临床预测因素。

结果

2011 年，在转介至姑息治疗诊所时，221 名癌症患者中有 96 名（43%）同时开具了阿片类药物/BZD-S。到 2016 年，这一比例逐渐下降至 217 名患者中的 67 名（P=.0008）。同时使用阿片类药物/BZD-S 组的女性（233 人；55%[P=.007]）和白人（323 人；77%[P=.002]）比例较高，患者报告的抑郁评分（P=.0001）、焦虑评分（P≤.0001）、嗜睡评分（P=.048）和最差的幸福感评分（P=.001）较高。同时使用阿片类药物/BZD-S 组的吗啡等效日剂量明显更高（中位数为 67.5mg/天[四分位距（IQR），30-135mg/天] vs 60mg/天[IQR，30-105mg/天]；P=.034）。多变量分析表明，焦虑（P≤.0001）、白种人（P=.0092）和较差的东部合作肿瘤学组表现状态（P=.0017）与同时使用显著相关。