Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Seagen Inc., Bothell, WA.
Urol Oncol. 2022 Sep;40(9):411.e9-411.e18. doi: 10.1016/j.urolonc.2022.06.013. Epub 2022 Aug 1.
Locally advanced or metastatic urothelial carcinoma (la/mUC) is an aggressive disease with a poor long-term survival. While patients frequently report pain, there are limited data on the patient experience with pain and pain medication use. This study used real-world data to quantify treatment with opioids, as a proxy for pain, in patients with la/mUC compared with matched non-cancer controls.
This was a retrospective claims analysis, using the IBM® MarketScan® databases, of adults diagnosed with urothelial carcinoma and initiating ≥1 la/mUC therapy between May 2016 and June 2019. Index date was date of first systemic therapy claim for la/mUC; baseline was the 6 months pre-index; follow-up was from index until disenrollment or study end. Proportion with treatment with opioids, number of opioid prescriptions, and daily morphine-equivalent dose (MEQ; in morphine milligram equivalents/day) in patients with la/mUC and matched non-cancer controls from the same databases were assessed.
We identified 1293 patients with la/mUC and matched 1:3 with 3862 non-cancer controls. Mean (SD) follow-up was 1.26 (0.74) years in patients with la/mUC and 1.29 (0.72) years in controls. A greater proportion of patients with la/mUC, compared with controls, used opioids during both baseline (63.6% vs. 19.4%) and follow-up (61.4% vs. 27.9%). Among those who used opioids, mean monthly prescriptions (number of medications claims/patient/month) were 0.55 both in patients with la/mUC and controls during baseline, and 0.49 and 0.39, respectively, at follow-up. Daily MEQ among those who used opioids was 53.6 and 45.7 during baseline, and 74.7 and 40.8 at follow-up, in patients with la/mUC and controls, respectively. In patients with la/mUC, mean opioid prescriptions and daily MEQ increased during later lines of therapy.
In patients with la/mUC, pain requiring opioids is common at diagnosis, worsens as the patient progresses, and is consistently higher than in matched controls. Improvement in disease control with more effective therapies may reduce cancer pain in this population.
局部晚期或转移性尿路上皮癌（la/mUC）是一种侵袭性疾病，长期生存预后差。尽管患者经常报告疼痛，但关于患者疼痛体验和疼痛药物使用的数据有限。本研究使用真实世界数据来量化 la/mUC 患者的阿片类药物治疗，作为疼痛的替代指标，并与匹配的非癌症对照进行比较。
这是一项回顾性的索赔分析，使用 IBM® MarketScan®数据库，对 2016 年 5 月至 2019 年 6 月期间诊断为尿路上皮癌并开始使用≥1 种 la/mUC 治疗的成年人进行分析。指数日期为首次使用 la/mUC 系统治疗的日期；基线期为指数前 6 个月；随访期从指数开始到退出或研究结束。评估 la/mUC 患者和来自相同数据库的匹配非癌症对照患者的阿片类药物治疗比例、阿片类药物处方数量和每日吗啡等效剂量（MEQ；以吗啡毫克当量/天计算）。
我们确定了 1293 名 la/mUC 患者，并与 3862 名非癌症对照患者进行了 1:3 的匹配。la/mUC 患者的平均（SD）随访时间为 1.26（0.74）年，对照组为 1.29（0.72）年。与对照组相比，基线期（63.6% vs. 19.4%）和随访期（61.4% vs. 27.9%）使用阿片类药物的患者比例更高。在使用阿片类药物的患者中，基线期每月（每月药物使用次数/患者）处方数在 la/mUC 患者和对照组中均为 0.55，随访期分别为 0.49 和 0.39。在使用阿片类药物的患者中，基线期每日 MEQ 分别为 53.6 和 45.7，随访期分别为 74.7 和 40.8，分别为 la/mUC 患者和对照组。在 la/mUC 患者中，随着治疗线数的增加，阿片类药物的处方数量和每日 MEQ 增加。
在 la/mUC 患者中，疼痛需要阿片类药物治疗是常见的，随着病情的进展而恶化，并且始终高于匹配的对照组。更有效的治疗方法改善疾病控制可能会减轻该人群的癌症疼痛。
