Baum Laura Van Metre, Kc Madhav, Soulos Pamela R, Jeffery Molly M, Ruddy Kathryn J, Lerro Catherine C, Lee Hana, Graham David J, Rivera Donna R, Leapman Michael S, Jairam Vikram, Dinan Michaela A, Gross Cary P, Park Henry S
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA.
J Natl Cancer Inst. 2024 Feb 8;116(2):316-323. doi: 10.1093/jnci/djad206.
The impact of ongoing efforts to decrease opioid use on patients with cancer remains undefined. Our objective was to determine trends in new and additional opioid use in patients with and without cancer.
This retrospective cohort study used data from Surveillance, Epidemiology, and End Results program-Medicare for opioid-naive patients with solid tumor malignancies diagnosed from 2012 through 2017 and a random sample of patients without cancer. We identified 238 470 eligible patients with cancer and further focused on 4 clinical strata: patients without cancer, patients with metastatic cancer, patients with nonmetastatic cancer treated with surgery alone ("surgery alone"), and patients with nonmetastatic cancer treated with surgery plus chemotherapy or radiation therapy ("surgery+"). We identified new, early additional, and long-term additional opioid use and calculated the change in predicted probability of these outcomes from 2012 to 2017.
New opioid use was higher in patients with cancer (46.4%) than in those without (6.9%) (P < .001). From 2012 to 2017, the predicted probability of new opioid use was more stable in the cancer strata (relative declines: 0.1% surgery alone; 2.4% surgery+; 8.8% metastatic cancer), than in the noncancer stratum (20.0%) (P < .001 for each cancer to noncancer comparison). Early additional use declined among surgery patients (‒14.9% and ‒17.5% for surgery alone and surgery+, respectively) but was stable among patients with metastatic disease (‒2.8%, P = .50).
Opioid prescribing declined over time at a slower rate in patients with cancer than in patients without cancer. Our study suggests important but tempered effects of the changing opioid climate on patients with cancer.
持续减少阿片类药物使用的努力对癌症患者的影响尚不明确。我们的目标是确定有癌症和无癌症患者中新发及额外使用阿片类药物的趋势。
这项回顾性队列研究使用了监测、流行病学和最终结果计划 - 医疗保险的数据，研究对象为2012年至2017年确诊的未使用过阿片类药物的实体瘤恶性肿瘤患者以及无癌症患者的随机样本。我们确定了238470名符合条件的癌症患者，并进一步聚焦于4个临床分层：无癌症患者、转移性癌症患者、仅接受手术治疗的非转移性癌症患者（“仅手术”）以及接受手术加化疗或放疗的非转移性癌症患者（“手术 +”）。我们确定了新发、早期额外及长期额外使用阿片类药物的情况，并计算了2012年至2017年这些结果的预测概率变化。
癌症患者中新发阿片类药物使用（46.4%）高于无癌症患者（6.9%）（P <.001）。从2012年到2017年，癌症分层中新发阿片类药物使用的预测概率比非癌症分层更稳定（相对下降：仅手术组为0.1%；手术 + 组为2.4%；转移性癌症组为8.8%），而非癌症分层下降了20.0%（每种癌症分层与非癌症分层比较，P <.001）。手术患者中早期额外使用量下降（仅手术组和手术 + 组分别下降14.9%和17.5%），但转移性疾病患者中则保持稳定（下降2.8%，P =.50）。
随着时间推移，癌症患者阿片类药物处方量下降速度比无癌症患者慢。我们的研究表明，不断变化的阿片类药物环境对癌症患者有重要但有限的影响。
