Department of Anaesthesia, Perioperative Medicine, Pain and Critical Care, The Royal Marsden NHS Foundation Trust, London, England.
Curr Opin Support Palliat Care. 2023 Jun 1;17(2):98-103. doi: 10.1097/SPC.0000000000000640. Epub 2023 Mar 3.
The misuse of opioids has increased significantly in recent decades. Historically, cancer patients have not been considered at risk of opioid misuse. However, cancer pain is common, and opioids are often prescribed. Guidelines addressing opioid misuse often exclude cancer patients. Given that misuse is associated with significant harm and a reduction in quality of life, it is important to understand the risk of opioid misuse in cancer patients and how we can recognise and treat it.
Early cancer diagnoses and treatments have improved cancer survival rates, leading to a larger population of cancer patients and survivors. Opioid use disorder (OUD) may precede a cancer diagnosis or may develop during or after treatment. The effect of OUD extends from an individual patient to a societal level. This review examines the increasing incidence of OUD in cancer patients, ways to identify patients with OUD such as behaviour change and screening scales, prevention of OUD such as limited and targeted opioid prescriptions, and evidence-based treatment suggestions for OUD.
OUD in cancer patients has only relatively recently been recognised as a growing problem. Early identification, involvement of the multidisciplinary team, and treatment can reduce the negative impact of OUD.
近年来,阿片类药物的滥用显著增加。从历史上看,癌症患者并不被认为有阿片类药物滥用的风险。然而,癌症疼痛很常见,阿片类药物经常被开处方。解决阿片类药物滥用问题的指南通常不包括癌症患者。鉴于滥用与严重伤害和生活质量下降有关,了解癌症患者阿片类药物滥用的风险以及如何识别和治疗它非常重要。
早期癌症诊断和治疗提高了癌症的存活率,导致更多的癌症患者和幸存者。阿片类药物使用障碍(OUD)可能先于癌症诊断,也可能在治疗期间或之后发生。OUD 的影响不仅限于个体患者,还会涉及到整个社会层面。这篇综述探讨了癌症患者中 OUD 发病率的增加,识别 OUD 患者的方法,如行为改变和筛查量表,OUD 的预防,如有限和有针对性的阿片类药物处方,以及 OUD 的循证治疗建议。
癌症患者的 OUD 直到最近才被认为是一个日益严重的问题。早期识别、多学科团队的参与和治疗可以减少 OUD 的负面影响。