Lu Zhanni, Zhang Ning, Giordano Sharon H, Zhao Hui
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer Med. 2022 Jun;11(11):2296-2307. doi: 10.1002/cam4.4610. Epub 2022 Feb 23.
Opioid therapy provides essential pain relief for cancer patients. We used the population-based Surveillance Epidemiology and End Results (SEER) linked with Medicare database to identify the patterns of opioid use and associated factors in pancreatic adenocarcinoma cancer patients 66 years or older.
We assessed opioid types, dispensed days, opioid uptake rates, and factors associated with opioid use after pancreatic adenocarcinoma cancer diagnosis in Medicare beneficiaries between 2007 and 2015 from the SEER-Medicare data. Multivariable regression analysis was used to adjust for a variety of patient-related factors.
We identified a cohort of 10,745 pancreatic cancer patients with a median age of 76 years old and median survival of 7 months; 75% of patients-initiated opioids after cancer diagnosis. African Americans had the lowest rate of opioid use of 69.1% compared with all other race/ethnicity groups at around 75%. No significant yearly trend of prescribing opioids was detected. Hydrocodone was the most frequently prescribed opioid type. Regression analysis revealed that age ≤80 years, residing in Southern or Western SEER registries, residing in urban/less urban versus big metro areas, having stage IV cancer at diagnosis, longer survival time, and undertaking cancer-directed treatment or using palliative care were positively associated with opioid initiation, more prescribed opioid types, and higher opioid doses.
While a range of sociodemographic variables were associated with opioid use in unadjusted analysis, the associations between race/ethnicity, gender, and socioeconomic status with opioid initiation disappeared when sociodemographic factors, tumor characteristics, and cancer treatment were adjusted.
Health care professionals' opioid prescription pattern for pancreatic cancer patients does not parallel the U.S. opioid epidemic. Racial/ethnic disparities in opioid treatment were not identified.
阿片类药物疗法为癌症患者提供了必要的疼痛缓解。我们利用基于人群的监测、流行病学和最终结果（SEER）数据库与医疗保险数据库相链接，来确定66岁及以上胰腺腺癌患者的阿片类药物使用模式及相关因素。
我们从SEER-医疗保险数据中评估了2007年至2015年医疗保险受益人中胰腺腺癌诊断后阿片类药物的类型、配发天数、阿片类药物使用率以及与阿片类药物使用相关的因素。采用多变量回归分析来调整各种与患者相关的因素。
我们确定了一个由10745名胰腺癌患者组成的队列，中位年龄为76岁，中位生存期为7个月；75%的患者在癌症诊断后开始使用阿片类药物。非裔美国人的阿片类药物使用率最低，为69.1%，而所有其他种族/族裔群体的使用率约为75%。未检测到阿片类药物处方的显著年度趋势。氢可酮是最常处方的阿片类药物类型。回归分析显示，年龄≤80岁、居住在SEER南部或西部登记处、居住在城市/城市化程度较低地区与大城市地区、诊断时为IV期癌症、生存期较长以及接受癌症导向治疗或使用姑息治疗与阿片类药物起始使用、更多处方阿片类药物类型和更高阿片类药物剂量呈正相关。
虽然在未调整分析中一系列社会人口统计学变量与阿片类药物使用有关，但在调整社会人口统计学因素、肿瘤特征和癌症治疗后，种族/族裔、性别和社会经济地位与阿片类药物起始使用之间的关联消失了。
医疗保健专业人员对胰腺癌患者的阿片类药物处方模式与美国阿片类药物流行情况不一致。未发现阿片类药物治疗中的种族/族裔差异。
