Department of Preventive Medicine and Population Health, University of Texas Medical Branch - Galveston, Galveston, TX, USA.
Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch - Galveston, Galveston, TX, USA.
Cancer Med. 2021 Mar;10(5):1550-1561. doi: 10.1002/cam4.3709. Epub 2021 Jan 9.
Older cancer survivors have high rates of long-term opioid therapy (≥90 days/year). However, the geographical and temporal variation in long-term opioid therapy rates for older cancer survivors is not known.
A retrospective cohort study was conducted using SEER-Medicare data. Persons aged ≥66 years, diagnosed with breast, colorectal, lung, or prostate cancer from 1991 to 2011, and alive ≥5 years after diagnosis were included. Persons were followed from 1/1/2008 until 12/31/2016. Persons were assigned to a census region in their state of residence each year. Individuals who were covered by an opioid prescription for at least 90 days in a calendar year were classified as having received long-term opioid therapy. Multivariable analysis was conducted using generalized estimating equations.
Temporal trends significantly varied by region (p < 0.0001) and opioid-naïve status (p < 0.0001). Compared to 2013, opioid-naïve cancer survivors in the south and non-naïve survivors in the south and west experienced significant declines in long-term opioid therapy in 2015 and 2016. Significant declines were observed in 2016 for opioid-naïve and non-naïve cancer survivors residing in the northeast and among opioid-naïve cancer survivors living in the Midwest.
The annual trends in the receipt of long-term opioid therapy significantly varied by region among older cancer survivors. Variation in a clinical practice suggests the need for more research and interventions to improve efficiency, process, cost, and quality of care.
老年癌症幸存者长期接受阿片类药物治疗（≥90 天/年）的比例较高。然而，尚不清楚老年癌症幸存者长期接受阿片类药物治疗的比率在地域和时间上的变化。
本研究使用 SEER-Medicare 数据进行了回顾性队列研究。纳入年龄≥66 岁、1991 年至 2011 年间被诊断患有乳腺癌、结直肠癌、肺癌或前列腺癌且在诊断后至少存活 5 年的患者。患者从 2008 年 1 月 1 日开始随访，直至 2016 年 12 月 31 日。每年根据患者居住州的普查区域对患者进行分组。在日历年中至少接受 90 天阿片类药物治疗的患者被归类为接受长期阿片类药物治疗。使用广义估计方程进行多变量分析。
时间趋势在地域上（p<0.0001）和阿片类药物初治状态上（p<0.0001）差异显著。与 2013 年相比，2015 年和 2016 年，南部阿片类药物初治癌症幸存者和南部及西部非初治幸存者的长期阿片类药物治疗率显著下降。2016 年，东北部阿片类药物初治和非初治癌症幸存者以及中西部阿片类药物初治癌症幸存者的治疗率均显著下降。
在地域上，老年癌症幸存者长期接受阿片类药物治疗的年度趋势差异显著。临床实践的差异表明，需要进行更多的研究和干预，以提高效率、流程、成本和护理质量。
