Takahashi Richi, Miyashita Mitsunori, Murakami Yoshitaka, Oba Mari S
Department of Medical Statistics, Toho University Graduate School of Medicine, Tokyo, Japan.
Yokohama Cancer Chemotherapy & Palliative Care Support Division, Toda Medical Care Group, Kanagawa, Japan.
Jpn J Clin Oncol. 2022 Nov 3;52(11):1297-1302. doi: 10.1093/jjco/hyac122.
Consumption of opioids, essential drugs for pain relief, has seen rapid growth worldwide. In Japan, where total opioid consumption still remains low among developed countries, little is known about trends in the clinical patterns of opioids in terminally ill cancer patients.
Patients who died of cancer from 2010 to 2019 were included in this study. Morphine, oxycodone, fentanyl, tapentadol, methadone and hydromorphone were examined as opioids for cancer pain. We calculated the prevalence of prescribed opioids prior to death by year and age group and the average opioid dose 30 days before death.
The total number of patients was 221 598. We found that the prescription prevalence of opioids increased from 60.8 to 65.9% (5.1%). Morphine was most prescribed in 2010 but had decreased prevalence (-9.0%) during the 10-year period. Oxycodone had the highest increase in prescription prevalence (13.7%), and fentanyl prevalence decreased (-4.9%). In the subgroup comparison, the prescription prevalence of opioids in the elderly was lower than that in the younger group; however, the increasing trend in the elderly was greater than that in the younger group. The percentage of patients prescribed low-dose opioids (<60 mg/day) during the 30 days before death increased by 4.9% and was the highest throughout the study period.
The prevalence of opioid prescriptions for terminally ill cancer patients has increased from 2010 to 2019 in Japan. The opioid-specific trends were similar to the global trend but differed by palliative care specialty.
阿片类药物作为缓解疼痛的基本药物，在全球范围内的消费量迅速增长。在日本，尽管阿片类药物的总消费量在发达国家中仍处于较低水平，但对于晚期癌症患者阿片类药物临床使用模式的趋势了解甚少。
本研究纳入了2010年至2019年死于癌症的患者。研究考察了吗啡、羟考酮、芬太尼、曲马多、美沙酮和氢吗啡酮等用于癌症疼痛的阿片类药物。我们计算了死亡前按年份和年龄组划分的阿片类药物处方流行率以及死亡前30天的平均阿片类药物剂量。
患者总数为221598人。我们发现阿片类药物的处方流行率从60.8%上升至65.9%（增长了5.1%）。吗啡在2010年的处方量最大，但在这10年期间流行率有所下降（-9.0%）。羟考酮的处方流行率增长最高（13.7%），而芬太尼的流行率下降了（-4.9%）。在亚组比较中，老年人的阿片类药物处方流行率低于年轻组；然而，老年人的增长趋势大于年轻组。在死亡前30天内开具低剂量阿片类药物（<60毫克/天）的患者比例增加了4.9%，且在整个研究期间是最高的。
2010年至2019年期间，日本晚期癌症患者的阿片类药物处方流行率有所上升。阿片类药物的特定趋势与全球趋势相似，但在姑息治疗专业方面存在差异。
