Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA.
Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA.
Support Care Cancer. 2020 Dec;28(12):5763-5770. doi: 10.1007/s00520-020-05420-1. Epub 2020 Mar 25.
Reducing high-risk prescription opioid use after surgery has become a key strategy in mitigating the opioid crisis. Yet, despite their vulnerabilities, we know little about how cancer survivors use opioids for non-cancer perioperative pain compared to those with no history of cancer. The purpose was to examine the association of cancer survivorship with the likelihood of receiving perioperative opioid therapy for non-cancer minor surgery.
Using 2007-2014 SEER-Medicare data for breast, colorectal, prostate, and non-cancer populations, we conducted retrospective cohort study of opioid-naïve Medicare beneficiaries who underwent one of six common minor non-cancer surgeries. Modified Poisson regression estimated the relative risk of receiving a perioperative opioid prescription associated with cancer survivorship compared to no history of cancer. Stabilized inverse probability of treatment weights were used to balance measurable covariates between cohorts.
We included 1486 opioid-naïve older adult cancer survivors and 3682 opioid-naïve non-cancer controls. Cancer survivorship was associated with a 5% lower risk of receiving a perioperative opioid prescription (95% confidence interval: 0.89, 1.00; p = 0.06) compared to no history of cancer. Cancer survivorship was not associated with the extent of perioperative opioid exposure.
Cancer survivors were slightly less likely to receive opioid therapy for non-cancer perioperative pain than those without a history of cancer. It is unclear if this reflects a reduced risk of opioid-related harms for cancer survivors or avoidance of appropriate perioperative pain therapy. Further examination of cancer survivors' experiences with and attitudes about opioids may inform improvements to non-cancer pain management for cancer survivors.
减少手术后高危处方类阿片药物的使用已成为缓解阿片类药物危机的关键策略。然而，尽管癌症幸存者存在脆弱性，但我们对他们在非癌症围手术期疼痛中使用阿片类药物的情况知之甚少，与没有癌症病史的人相比。本研究旨在探讨癌症生存与接受非癌症小手术围手术期阿片类药物治疗的可能性之间的关联。
使用 2007-2014 年 SEER-Medicare 数据，对接受六种常见非癌症小手术之一的阿片类药物初治 Medicare 受益人群进行回顾性队列研究。采用校正泊松回归估计与癌症生存相比，无癌症病史患者接受围手术期阿片类药物处方的相对风险。采用稳定逆概率处理权重法平衡队列间可测量的协变量。
共纳入 1486 名阿片类药物初治老年癌症幸存者和 3682 名阿片类药物初治非癌症对照者。与无癌症病史相比，癌症生存与接受围手术期阿片类药物处方的风险降低 5%（95%置信区间：0.89，1.00；p=0.06）相关。癌症生存与围手术期阿片类药物暴露程度无关。
与无癌症病史者相比，癌症幸存者接受非癌症围手术期疼痛阿片类药物治疗的可能性略低。这是否反映了癌症幸存者阿片类药物相关危害的风险降低，还是避免了适当的围手术期疼痛治疗，尚不清楚。进一步研究癌症幸存者对阿片类药物的体验和态度可能有助于改善癌症幸存者的非癌症疼痛管理。
