Sumimoto Hidetoshi, Hayashi Komaki, Kimura Yuri, Nishikawa Akihito, Hattori Seiko, Hasegawa Chiaki, Morii Hiroaki, Teramoto Koji, Morita Sachiyo, Daigo Yataro
Department of Medical Oncology, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
Cancer Center, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
Palliat Med Rep. 2021 Sep 15;2(1):237-241. doi: 10.1089/pmr.2021.0037. eCollection 2021.
There are no universal tools to predict the necessity of high-dose opioid use for cancer-related pain. Early recognition and interventions for intractable cancer pain could minimize the distress of palliative patients. We sought to identify the clinical factors associated with high-dose opioid use in advanced cancer patients to recognize palliative patients who would develop intractable cancer pain, as early as possible. Among 385 in-hospital cancer patients from April 1, 2014 to July 31, 2019, who were referred to the palliative care team for cancer-related pain, clinical factors significantly correlated to high-dose opioid use were retrospectively analyzed. We conducted a multiple logistic regression analysis to identify variables significantly related to high-dose opioid use (>120 mg/day oral morphine equivalent dose). Independent factors of high-dose opioid use included younger age (odds ratio [OR] 0.965, 95% confidence interval [CI] 0.944-0.986, = 0.001), respiratory cancers (OR 1.882, 95% CI 1.069-3.312, < 0.001), and opioid switch (OR 2.869, 95% CI 1.497-5.497, = 0.001). The percentage of correct classifications of the regression equation was 86.9%. Younger age, respiratory cancers, and opioid switch were related to high-dose opioid use. Our findings may help palliative caregivers to deal with intractable cancer pain in palliative patients, and thus relieve their distress.
目前尚无通用工具可预测癌症相关疼痛患者使用高剂量阿片类药物的必要性。对顽固性癌症疼痛进行早期识别和干预可将姑息治疗患者的痛苦降至最低。我们试图确定晚期癌症患者中与高剂量阿片类药物使用相关的临床因素，以便尽早识别出可能发展为顽固性癌症疼痛的姑息治疗患者。在2014年4月1日至2019年7月31日期间因癌症相关疼痛被转诊至姑息治疗团队的385例住院癌症患者中，对与高剂量阿片类药物使用显著相关的临床因素进行了回顾性分析。我们进行了多因素逻辑回归分析，以确定与高剂量阿片类药物使用（口服吗啡等效剂量>120mg/天）显著相关的变量。高剂量阿片类药物使用的独立因素包括年龄较小（比值比[OR]0.965，95%置信区间[CI]0.944-0.986，P=0.001）、呼吸道癌症（OR 1.882，95%CI 1.069-3.312，P<0.001）和阿片类药物转换（OR 2.869，95%CI 1.497-5.497，P=0.001）。回归方程的正确分类百分比为86.9%。年龄较小、呼吸道癌症和阿片类药物转换与高剂量阿片类药物使用有关。我们的研究结果可能有助于姑息治疗护理人员应对姑息治疗患者的顽固性癌症疼痛，从而减轻他们的痛苦。
