Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2022 Oct;128(20):3718-3726. doi: 10.1002/cncr.34392. Epub 2022 Aug 23.
Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention.
A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained.
NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13).
Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior.
鲜有研究评估针对癌症患者非医疗性阿片类药物使用（NMOU）行为的干预措施。作者开发了同情高警报团队（CHAT）干预措施，以管理接受阿片类药物治疗癌症疼痛且表现出 NMOU 行为的患者。本研究的目的是确定接受干预的患者 NMOU 行为、疼痛强度和阿片类药物需求的频率变化。
共对 130 名接受阿片类药物治疗癌症疼痛且有 NMOU 证据的患者进行了回顾。获得了基线、3 个月和 6 个月时的人口统计学和临床信息，如 NMOU 行为、疼痛评分和吗啡等效日剂量。
NMOU 行为从基线时的中位数（四分位距）2（1-3）显著减少至 3 个月时的 0（0-1）（p<0.001）和 6 个月时的 0（0-1）（p<0.001）。在 3 个月和 6 个月时，分别有 45 名（60%）和 31 名（62%）接受 CHAT 治疗的患者对干预完全有反应。基线 NMOU 行为次数较高与患者对干预的反应独立相关（优势比[OR]，1.97；95%置信区间[CI]，1.09-4.28，p=0.049，3 个月；OR，2.5；95%CI，1.20-6.47，p=0.03，6 个月）。中位疼痛评分从基线时的 7 分降至 3 个月和 6 个月时的 6 分（p=0.01）。同期，吗啡等效日剂量无明显变化（143mg/天比 139mg/天，p=0.13）。
接受 CHAT 干预的大多数患者在干预后 3 个月和 6 个月时 NMOU 行为和疼痛强度评分均有所改善。这些初步发现支持 CHAT 在管理接受阿片类药物治疗癌症疼痛且表现出 NMOU 行为的患者方面的疗效。
