Pain and Palliative Care Unit, Kappy and Eric Flanders National Palliative Care Resource Center, The Haim Doron Division of Community Health,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO BOX 653, Beer-Sheva, Israel.
Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Support Care Cancer. 2023 Sep 5;31(10):560. doi: 10.1007/s00520-023-08027-4.
Opioids are the cornerstone of therapy for cancer patients with moderate to severe pain. The objective was to characterize opioid purchases by cancer patients in Clalit Health Services (CHS), the largest Health Maintenance Organization in Israel, over the years 2007-2018.
Data for all CHS cancer patients aged 18 years old and above who purchased an opioid at least once during the 12-year study period were obtained from computerized databases. The amount of opioids was converted into oral morphine equivalents (OME).
108,543 cancer patients who purchased opioids at least once were enrolled. They comprised 30.5% of the CHS purchasers of opioids in the study period. The total number of cancer patients who purchased an opioid at least once increased gradually from 13,057 in 2007 to 20,675 (58% increase) in 2018, while the annual number of CHS cancer patients increased by only 39%. The annual OME per capita increased from 753 mg in 2007 to 1,432 mg in 2018 (91% increase). In 2007 8.1% of the cancer patients purchased opioids and 9.2% in 2018. Two thirds of all cancer patients purchased opioids for three months or less, 11.9% continued for more than one year, and 5.8% for more than two years.
There is a clinically non-significant increase in the rate of cancer patients purchasing opioids. About two thirds of the cancer patients purchased opioids for only three months, and 94% for up to two years. Under-treatment of cancer pain should still be of concern. While patients are prescribed higher doses, under-prescription may still be a problem..
阿片类药物是中重度癌痛患者治疗的基石。本研究旨在描述 2007 年至 2018 年期间，以色列最大的医疗保健组织克拉利特健康服务（Clalit Health Services，CHS）中癌症患者的阿片类药物购买情况。
从计算机数据库中获取了在 12 年研究期间至少购买过一次阿片类药物的所有年龄在 18 岁及以上的 CHS 癌症患者的数据。将阿片类药物的用量转换为口服吗啡等效物（oral morphine equivalents，OME）。
共纳入了 108543 名至少购买过一次阿片类药物的癌症患者。他们占研究期间 CHS 阿片类药物购买者的 30.5%。至少购买过一次阿片类药物的癌症患者总数从 2007 年的 13057 例逐渐增加到 2018 年的 20675 例（增加了 58%），而同期 CHS 癌症患者的年增长率仅为 39%。人均年 OME 从 2007 年的 753mg 增加到 2018 年的 1432mg（增加了 91%）。2007 年有 8.1%的癌症患者购买阿片类药物，2018 年为 9.2%。三分之二的癌症患者购买阿片类药物的时间在三个月或更短，11.9%的患者持续使用一年以上，5.8%的患者持续使用两年以上。
购买阿片类药物的癌症患者比例略有上升，但无统计学意义。大约三分之二的癌症患者只购买了三个月的阿片类药物，94%的患者购买了不超过两年的阿片类药物。癌症疼痛的治疗不足仍应引起关注。虽然患者的处方剂量较高，但仍可能存在处方不足的问题。
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