1Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
2Palliative Research Center (PaRC), and.
J Natl Compr Canc Netw. 2022 Mar 1;20(5):460-467.e1. doi: 10.6004/jnccn.2021.7104.
Given limited evidence on opioid prescribing among patients receiving treatment for cancer during the ongoing opioid epidemic, our objective was to assess predictors of and trends in opioid receipt during cancer treatment, including how patterns differ by type of cancer.
Using cancer registry data, we identified patients with a first lifetime primary diagnosis of breast, colorectal, or lung cancer from 2013 to 2017 who underwent treatment within a large cancer center network. Cancer registry data were linked to electronic health record information on opioid prescriptions. We examined predictors of and trends in receipt of any opioid prescription within 12 months of cancer diagnosis.
The percentage of patients receiving opioids varied by cancer type: breast cancer, 35% (1,996/5,649); colorectal, 37% (776/2,083); lung, 47% (1,259/2,654). In multivariable analysis, opioid use in the year before cancer diagnosis was the factor most strongly associated with receipt of opioids after cancer diagnosis, with 4.90 (95% CI, 4.10-5.86), 5.09 (95% CI, 3.88-6.69), and 3.31 (95% CI, 2.68-4.10) higher odds for breast, colorectal, and lung cancers, respectively. We did not observe a consistent decline in opioid prescribing over time, and trends differed by cancer type.
Our findings suggest that prescription of opioids to patients with cancer varies by cancer type and other factors. In particular, patients are more likely to receive opioids after cancer diagnosis if they were previously exposed before diagnosis, suggesting that pain among patients with cancer may commonly include non-cancer-related pain. Heterogeneity and complexity among patients with cancer must be accounted for in developing policies and guidelines aimed at addressing pain management while minimizing the risk of opioid misuse.
在当前阿片类药物流行期间，针对接受癌症治疗的患者开具阿片类药物的证据有限，我们的目标是评估癌症治疗期间开具阿片类药物的预测因素和趋势，包括不同癌症类型的模式差异。
我们使用癌症登记数据，从 2013 年至 2017 年确定了在大型癌症中心网络内接受治疗的首次终生原发性乳腺癌、结直肠癌或肺癌患者。癌症登记数据与电子健康记录中关于阿片类药物处方的信息相关联。我们检查了癌症诊断后 12 个月内接受任何阿片类药物处方的预测因素和趋势。
接受阿片类药物的患者比例因癌症类型而异：乳腺癌，35%（1996/5649）；结直肠癌，37%（776/2083）；肺癌，47%（1259/2654）。在多变量分析中，癌症诊断前一年使用阿片类药物是与癌症诊断后使用阿片类药物最密切相关的因素，乳腺癌、结直肠癌和肺癌的比值比分别为 4.90（95%CI，4.10-5.86）、5.09（95%CI，3.88-6.69）和 3.31（95%CI，2.68-4.10）。我们没有观察到阿片类药物开具随时间的持续下降，而且趋势因癌症类型而异。
我们的研究结果表明，开具阿片类药物给癌症患者的情况因癌症类型和其他因素而异。特别是，如果患者在癌症诊断前有过阿片类药物暴露，那么他们在癌症诊断后更有可能接受阿片类药物，这表明癌症患者的疼痛通常可能包括与癌症无关的疼痛。在制定旨在解决疼痛管理问题同时最大限度减少阿片类药物滥用风险的政策和指南时，必须考虑到癌症患者的异质性和复杂性。
