Department of Psychosocial Oncology and Palliative Care (M.Y., B.K., I.S.C.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (M.Y., S.E.F.M., G.D.S., I.S.C.), Boston, Massachusetts, USA.
Department of Pathology (S.E.F.M., P.K.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (M.Y., S.E.F.M., G.D.S., I.S.C.), Boston, Massachusetts, USA.
J Pain Symptom Manage. 2024 Jul;68(1):e36-e45. doi: 10.1016/j.jpainsymman.2024.04.006. Epub 2024 Apr 9.
Opioid therapy is a cornerstone for treatment of cancer-related pain, but standardized management practices for patients with cancer and aberrant urine drug test (UDT) results are lacking.
To identify the prevalence of UDT ordering (both screening and definitive testing) in the oncology setting and to examine clinician management practices for patients with cancer on opioid therapy with aberrant definitive UDT results.
We conducted a retrospective chart review of patients with cancer on opioid therapy at an academic cancer center in the United States. Outcomes included UDT ordering patterns and clinician management practices in response to aberrant definitive UDT results.
Our study revealed an overall UDT ordering rate of 3.7% among 10,371 patients with cancer on opioid therapy. Among 143 patients for whom definitive UDTs were ordered, oncologists only ordered 14 (9.8%) UDTs, while palliative care ordered the majority (n = 129; 90.2%). Fifty-five (38.5%) patients had aberrant results, and the most common aberrancy was presence of illicit drugs 22 [15.4%]. Clinicians rarely made medication changes (20 [36.4%]) when UDT results were aberrant, and in the setting of possible fentanyl use (n = 8), only 3 (37.5%) patients were started/switched to methadone, and none were started/switched to buprenorphine.
Overall UDT ordering was infrequent for patients with cancer on opioid therapy, especially by oncologists, and clinicians rarely made prescribing changes when definitive UDT results were aberrant. More definitive guidance related to UDT ordering and opioid management are needed for patients with cancer and aberrant UDT results.
阿片类药物疗法是治疗癌痛的基石，但缺乏针对癌症患者和尿液药物检测（UDT）异常结果的标准化管理实践。
确定肿瘤学环境中 UDT 检测（包括筛查和明确检测）的流行情况，并研究癌症患者接受阿片类药物治疗时出现异常明确 UDT 结果的临床医生管理实践。
我们对美国一家学术癌症中心接受阿片类药物治疗的癌症患者进行了回顾性病历审查。结果包括 UDT 检测的开具模式和临床医生对异常明确 UDT 结果的管理实践。
我们的研究显示，在 10371 名接受阿片类药物治疗的癌症患者中，UDT 检测的总体开具率为 3.7%。在 143 名接受明确 UDT 检测的患者中，肿瘤医生仅开具了 14 次 UDT 检测（9.8%），而姑息治疗医生开具了大部分 UDT 检测（n=129；90.2%）。55 名（38.5%）患者的 UDT 结果异常，最常见的异常是存在非法药物 22 例（15.4%）。当 UDT 结果异常时，临床医生很少改变药物治疗方案（20 例[36.4%]），在可能使用芬太尼的情况下（n=8），只有 3 例（37.5%）患者开始/转换为美沙酮，没有患者开始/转换为丁丙诺啡。
接受阿片类药物治疗的癌症患者的 UDT 总体检测率较低，特别是肿瘤医生开具的 UDT 检测较少，当明确的 UDT 检测结果异常时，临床医生很少改变处方。对于癌症患者和 UDT 异常结果的患者，需要更明确的 UDT 检测和阿片类药物管理指南。
