喉癌治疗后的慢性阿片类药物使用。
Chronic opioid use after laryngeal cancer treatment.
机构信息
Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA.
College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.
出版信息
Head Neck. 2021 Apr;43(4):1242-1251. doi: 10.1002/hed.26591. Epub 2020 Dec 28.
BACKGROUND
Survivors of head and neck cancer may be at increased risk for chronic opioid use and questions remain about risk factors.
METHODS
Retrospective study of patients with laryngeal cancer prescribed opioids utilizing the Truven Health Marketscan database. Patients had laryngeal cancer, underwent treatment, filled an opioid prescription, and were enrolled in this private insurance plan 1 year prior to and after treatment.
RESULTS
In this study, 7484 patients were included; 17.2% developed chronic opioid use, defined as consecutive opioid fills at least 90 days after treatment cessation. Early opioid use (OR = 3.607, 95% CI [3.125-4.163]), tobacco use (OR = 1.28, 95% CI [1.117-1.467]), median morphine milligram equivalent (MME; OR = 1.001, 95% CI [1.000-1.0001]), and radiation alone (OR = 1.435, 95% CI [1.199-1.717]) were predictive of chronic opioid use.
CONCLUSIONS
Nearly one in five patients prescribed opioids during treatment developed chronic use. Providers should discuss the risk of chronic opioid use, set expectations for opioid weaning, and consider adjunct pain regimens to develop effective pain management strategies.
背景
头颈部癌症幸存者可能有长期使用阿片类药物的风险，其风险因素仍存在疑问。
方法
利用 Truven Health Marketscan 数据库，对接受喉癌治疗并开具阿片类药物处方的患者进行回顾性研究。患者患有喉癌，接受了治疗，开了阿片类药物处方，并在治疗前和治疗后 1 年参加了这项私人保险计划。
结果
本研究共纳入 7484 例患者；17.2%的患者发生慢性阿片类药物使用，定义为连续使用阿片类药物至少 90 天。早期使用阿片类药物（OR = 3.607，95%CI [3.125-4.163]）、吸烟（OR = 1.28，95%CI [1.117-1.467]）、中位数吗啡毫克当量（MME；OR = 1.001，95%CI [1.000-1.0001]）和单纯放疗（OR = 1.435，95%CI [1.199-1.717]）是预测慢性阿片类药物使用的因素。
结论
近五分之一接受治疗时开具阿片类药物处方的患者发生了慢性使用。医务人员应讨论慢性阿片类药物使用的风险，为阿片类药物停药设定预期，并考虑辅助止痛方案，以制定有效的疼痛管理策略。
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