Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA.
Department of Psychiatry, West Virginia University, Morgantown, West Virginia, USA.
J Pain Symptom Manage. 2021 Sep;62(3):e156-e163. doi: 10.1016/j.jpainsymman.2021.05.002. Epub 2021 May 11.
The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer.
We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain.
Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization.
A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (-3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups.
Our results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.
阿片类药物泛滥促使出台了旨在减少不当处方的指南。尽管这些建议将急性癌症相关疼痛排除在外，但研究表明，晚期癌症住院患者的阿片类药物处方量有所减少。
我们进行了一项匹配病例对照分析，以确定阿片类药物使用障碍（OUD）病史如何影响癌症疼痛的住院管理。
回顾性分析了 2015 年至 2020 年因癌症疼痛入院且有 OUD 病史的患者的病历。通过患者年龄和性别进行 1:1 匹配。家庭吗啡毫克当量/天（MME/day）是根据家庭用药清单计算得出的。入院 MME/day 是指住院期间平均给予的 MME/day。
共匹配了 80 例住院患者（40 例有 OUD 病史，40 例无 OUD 病史），其中 25 例患者有 OUD 病史，31 例患者无 OUD 病史。70%的入院患者癌症处于转移/复发阶段。中位总生存期为 2.3 个月（95%CI 0-5.21，P=0.13）。OUD 患者从家庭到入院 MME/day 的变化明显较小（-3 与 37，P<0.01），且入院 MME/day 增加的可能性较小（OR 0.1，95%CI 0.02-0.43，P<0.01）。在考虑疼痛专科咨询后给予的阿片类药物时，两组之间没有差异。
我们的结果表明，OUD 患者接受的癌症相关疼痛住院管理质量较低。为 OUD 患者提供公平和富有同情心的临终关怀，需要对提供者进行教育并尽早让疼痛专家参与。
