Talwar Ashna, Rege Sanika, Aparasu Rajender R
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
Explor Res Clin Soc Pharm. 2022 Jul 4;6:100155. doi: 10.1016/j.rcsop.2022.100155. eCollection 2022 Jun.
Pain is a significant problem in patients with breast cancer. Limited data exist regarding the nature and extent of pain management in women with breast cancer visiting outpatient settings. This study examined the pain management practices and the factors associated with prescribing pain medications among breast cancer patients.
This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) 2011-2016, nationally representative outpatient survey data. Women (age ≥18 years) with breast cancer as the primary diagnosis were included. Weighted descriptive analyses examined national-level pain management practices, while multivariable logistic regression evaluated the factors associated with the prescribing of pain medications and opioids.
There were 23.95 million (95% confidence interval [CI], 19.29-28.60) outpatient visits for breast cancer during the study period. Pain medications were prescribed in 27.12% of these visits, with non-opioids prescribed in 17.13% and opioids in 15.16% of visits. Logistic regression analyses revealed that patients on Medicaid/other state-based insurance (odds ratio [OR] =2.38, 95% CI:1.15-4.93), those visiting general/family practice physicians (OR = 3.18, 95% CI:1.22-8.29) and patients receiving adjuvant pain medications (OR = 4.74, 95% CI: 3.10-7.24) were associated with a greater odds of receiving pain medications; while patients who were white (OR = 0.50, 95% CI:0.3-0.85), those residing in the northeast region (OR = 0.31, 95% CI: 0.10-0.99), and non-primary care provider visits (OR = 0.37, 95% CI:0.15-0.94) were associated with lower odds of receiving pain medications. Regional variations were observed among those receiving pain medications: women in the Northeast (OR = 0.06, 95% CI:0.01-0.29), Midwest (OR = 0.15, 95% CI:0.04-0.62), and South (OR = 0.24, 95% CI:0.06-0.92) regions were less likely to receive opioids. However, patients visiting general and family practice specialties (OR = 6.76, 95% CI:1.71-26.70) were more likely to prescribe opioids than non-opioids.
The national survey data revealed one in four women visits and one in seven office visits for breast cancer received pain medication prescriptions and opioid medications, respectively. Both patient and provider characteristics contribute to variations in pain management in breast cancer patients. Further research is needed to evaluate the long-term consequences of these variations in breast cancer.
疼痛是乳腺癌患者的一个重要问题。关于乳腺癌女性患者在门诊环境中疼痛管理的性质和程度，现有数据有限。本研究调查了乳腺癌患者的疼痛管理实践以及与开具止痛药物相关的因素。
这项横断面研究使用了2011 - 2016年全国门诊医疗护理调查（NAMCS），这是具有全国代表性的门诊调查数据。纳入以乳腺癌为主要诊断的18岁及以上女性。加权描述性分析考察了全国范围内的疼痛管理实践，而多变量逻辑回归评估了与开具止痛药物和阿片类药物相关的因素。
在研究期间，乳腺癌门诊就诊人次达2395万（95%置信区间[CI]，1929 - 2860万）。其中27.12%的就诊开具了止痛药物，17.13%的就诊开具了非阿片类药物，15.16%的就诊开具了阿片类药物。逻辑回归分析显示，参加医疗补助/其他州立保险的患者（比值比[OR]=2.38，95%CI：1.15 - 4.93）、就诊于普通/家庭医生的患者（OR = 3.18，95%CI：1.22 - 8.29）以及接受辅助止痛药物治疗的患者（OR = 4.74，95%CI：3.10 - 7.24）更有可能接受止痛药物治疗；而白人患者（OR = 0.50，95%CI：0.3 - 0.85）、居住在东北地区的患者（OR = 0.31，95%CI：0.10 - 0.99）以及非初级保健提供者就诊的患者（OR = 0.37，95%CI：0.15 - 0.94）接受止痛药物治疗的可能性较低。在接受止痛药物治疗的患者中观察到地区差异：东北地区（OR = 0.06，95%CI：0.01 - 0.29）、中西部地区（OR = 0.15，95%CI：0.04 - 0.62）和南部地区（OR = 0.24，95%CI：0.06 - 0.92）的女性接受阿片类药物的可能性较小。然而，就诊于普通和家庭专科的患者（OR = 6.76，95%CI：1.71 - 26.70）开具阿片类药物的可能性高于非阿片类药物。
全国调查数据显示，四分之一的乳腺癌女性门诊就诊者和七分之一的乳腺癌门诊办公室就诊者分别接受了止痛药物处方和阿片类药物处方。患者和提供者的特征均导致乳腺癌患者疼痛管理存在差异。需要进一步研究来评估这些差异对乳腺癌的长期影响。
