Rueter Manuela, Baricault Bérangère, Lapeyre-Mestre Maryse
Medical and Clinical Pharmacology Unit, University Hospital Centre Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; Clinical Investigation Center (CIC) 1436, University Hospital Centre Toulouse, 31059 Toulouse cedex 9, France; Equipe Pharmacologie en Population, cohorteS, biobanqueS, PEPPS, Toulouse University, 31000 Toulouse, France.
Medical and Clinical Pharmacology Unit, University Hospital Centre Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France.
Therapie. 2022 Nov-Dec;77(6):703-711. doi: 10.1016/j.therap.2022.01.019. Epub 2022 Feb 6.
Cancer pain management with adequate analgesics for cancer outpatients can be particularly challenging. This representative retrospective cohort study aimed to investigate the prevalence and timing of weak and strong opioid analgesic prescriptions in cancer outpatients during their last year of life, with a focus on factors associated to potential late strong opioid initiation. Factors associated with late strong opioid initiation were investigated through multivariate logistic regression analyses stratified by place of death. A retrospective cohort of cancer outpatients, who died between 2014 and 2016, was identified from the general sample of beneficiaries. Among N=4704 cancer patients (median age 76 years, 42.7% women), 3002 (63.8%) were prescribed and dispensed ≥1 weak or strong opioid analgesic during their last year of life; of whom, 2458 (52.3%) received ≥1 weak opioid analgesic (tramadol as single-ingredient accounting for 25.9%) and 1733 (36.8%) ≥1 strong opioid analgesic dispensation (fentanyl 21.6%). Median interval between the first prescription for any strong opioid and death was 18 weeks (interquartile range: 8-38), and for weak opioids 33 weeks (interquartile range: 20-47). Among weak opioid users, 1229 (50.0%) patients had received ≥1 weak opioid analgesic dispensation during the year n-2 before death. Among strong opioid users, 986 (56.9%) patients had received ≥1 weak opioid analgesic dispensation during the year n-2 before death and 381 (21.9%) patients ≥1 strong opioid analgesic dispensation. Patients with an outpatient death were more likely to have a late strong opioid initiation compared to patients with an inpatient death. Late strong opioid initiation (<18 weeks before death) was significantly associated with a lower number of hospitalization days and prior weak opioid exposure for patients with an inpatient death and, with older age, social, prior weak opioid exposure, and a prescription initiation by general practitioner for patients with an outpatient death. Our gained knowledge of opioid prescribing patterns in cancer patients during the last year of life might help to progress opioid analgesic treatment and to improve patient outcomes.
为癌症门诊患者提供足够的镇痛药来管理癌症疼痛可能极具挑战性。这项具有代表性的回顾性队列研究旨在调查癌症门诊患者在生命最后一年使用弱阿片类镇痛药和强阿片类镇痛药处方的患病率及时间，重点关注与潜在晚期开始使用强阿片类药物相关的因素。通过按死亡地点分层的多变量逻辑回归分析，研究与晚期开始使用强阿片类药物相关的因素。从受益人的总体样本中确定了2014年至2016年期间死亡的癌症门诊患者回顾性队列。在N = 4704例癌症患者（中位年龄76岁，42.7%为女性）中，3002例（63.8%）在生命最后一年被开具并配给了≥1种弱阿片类或强阿片类镇痛药；其中，2458例（52.3%）接受了≥1种弱阿片类镇痛药（曲马多单成分制剂占25.9%），1733例（36.8%）接受了≥1种强阿片类镇痛药配给（芬太尼占21.6%）。首次开具任何强阿片类药物处方至死亡的中位间隔时间为18周（四分位间距：8 - 38周），弱阿片类药物为33周（四分位间距：20 - 47周）。在使用弱阿片类药物的患者中，1229例（50.0%）在死亡前第n - 2年期间接受了≥1次弱阿片类镇痛药配给。在使用强阿片类药物的患者中，986例（56.9%）在死亡前第n - 2年期间接受了≥1次弱阿片类镇痛药配给，381例（21.9%）接受了≥1次强阿片类镇痛药配给。与住院死亡的患者相比，门诊死亡的患者更有可能晚期开始使用强阿片类药物。晚期开始使用强阿片类药物（死亡前<18周）与住院死亡患者的住院天数减少以及之前使用弱阿片类药物显著相关，对于门诊死亡患者，则与年龄较大、社会因素、之前使用弱阿片类药物以及由全科医生开具处方起始用药显著相关。我们对癌症患者生命最后一年阿片类药物处方模式的了解，可能有助于推进阿片类镇痛药治疗并改善患者结局。
