Division of Quality Assurance Program, National Cancer Center, Tokyo, Japan.
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan.
Jpn J Clin Oncol. 2023 Aug 30;53(9):823-828. doi: 10.1093/jjco/hyad058.
Cancer patients often have impaired renal and hepatic function. Opioids are essential to relieve painful symptoms in cancer patients. However, it is unknown which opioids are first prescribed for cancer patients with renal and hepatic impairment. The objective is to investigate the association between the type of first prescribed opioids and the renal/hepatic function of cancer patients.
We used a multicenter database from 2010 to 2019. The number of days from the first opioid prescription to the death was defined as the prognostic period. This period was divided into six categories. The prevalence of opioid prescriptions was calculated for each assessment of renal and hepatic function, divided into prognostic periods. Multinomial logistic regression analysis was used to explore the influence of renal and hepatic function on the first opioid choice.
The study included 11 945 patients who died of cancer. In all prognostic period categories, the patients with worse renal function received fewer morphine prescriptions. No trend was observed in hepatic function. The odds ratio of oxycodone to morphine with reference to estimated glomerular filtration rate (eGFR) ≥90 was 1.707 (95% confidence interval: 1.433-2.034) for estimated glomerular filtration rate <30. The odds ratio of fentanyl to morphine with reference to estimated glomerular filtration rate ≥90 was 1.785 (95% confidence interval: 1.492-2.134) for estimated glomerular filtration rate <30. No association was identified between hepatic function and the choice of prescribed opioids.
Cancer patients with renal impairment tended to avoid morphine prescriptions, and no specific trend was observed in cancer patients with hepatic impairment.
癌症患者常伴有肾功能和肝功能损伤。阿片类药物对于缓解癌症患者的疼痛症状至关重要。然而，对于伴有肾功能和肝功能损伤的癌症患者，哪种阿片类药物是首先开具的尚不清楚。本研究旨在探讨首次开具的阿片类药物类型与癌症患者的肾功能和肝功能之间的关系。
我们使用了 2010 年至 2019 年的多中心数据库。从首次开具阿片类药物处方到死亡的天数定义为预后期。该时期被分为六个类别。计算了每个肾功能和肝功能评估时的阿片类药物处方的流行率，并按预后期进行了划分。采用多项逻辑回归分析探讨了肾功能和肝功能对首次阿片类药物选择的影响。
本研究纳入了 11 945 例死于癌症的患者。在所有预后期类别中，肾功能越差的患者接受的吗啡处方越少。肝功能则没有观察到趋势。以肾小球滤过率（eGFR）≥90 为参考，估算肾小球滤过率（eGFR）<30 时，与吗啡相比，羟考酮的优势比（OR）为 1.707（95%可信区间：1.433-2.034）；以 eGFR≥90 为参考，与吗啡相比，芬太尼的 OR 为 1.785（95%可信区间：1.492-2.134）。肝功能与所开阿片类药物的选择之间无关联。
肾功能受损的癌症患者倾向于避免开具吗啡处方，而肝功能受损的癌症患者则无特定的处方趋势。
