Adhikari Biplov, Shrestha Nistha, Bhatt Vijaya Raj
Medstar Health Internal Medicine Residency Program, 201 E University Pkwy, Baltimore, MD, USA.
Department of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, USA.
J Cancer Surviv. 2024 May 25. doi: 10.1007/s11764-024-01621-3.
Up to 40% patients with cancer reporting pain may not receive optimal analgesia indicating inadequate treatment of pain. We examined the patterns of outpatient pain management in patients with cancer who reported pain.
We used the National Ambulatory Medical Care Survey data for outpatient visits from 2006 to 2018 for patients with any cancer and reporting pain. The primary outcome was prescription of pain medications among these patients. We performed multinomial logistic regression to identify factors associated with analgesic prescriptions among patients with cancer who reported pain.
We captured an estimated total of 412 million outpatient visits of which 22 million visits dealt with patients with cancer reporting pain. An estimated total of 13.8 million (61.33%) patient visits had pain reported but were not prescribed any pain medications. 5.5 million (24.44%) patient visits had non-opioid analgesic prescription while opioid analgesics were prescribed during 3.2 million (14.22%) visits. Patients who were black, aged 45-64 years, residing in rural geographical areas, visiting medical subspecialty practices, and having cancers of the respiratory and digestive systems had higher odds of receiving opioid prescription.
As one of the largest pain management studies among patients with cancer in the outpatient setting, covering 412 million patient visits, our study shows that a significant proportion of patients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain.
Undertreatment of pain continues to remain a major unmet need in patients with cancer.
高达40%报告有疼痛的癌症患者可能未得到最佳镇痛治疗，这表明疼痛治疗不充分。我们研究了报告有疼痛的癌症患者的门诊疼痛管理模式。
我们使用了2006年至2018年全国门诊医疗护理调查数据，该数据涉及任何癌症且报告有疼痛的患者的门诊就诊情况。主要结局是这些患者中疼痛药物的处方情况。我们进行了多项逻辑回归分析，以确定报告有疼痛的癌症患者中与镇痛处方相关的因素。
我们估计共捕获了4.12亿次门诊就诊，其中2200万次就诊涉及报告有疼痛的癌症患者。估计共有1380万（61.33%）次患者就诊报告有疼痛，但未开具任何疼痛药物处方。550万（24.44%）次患者就诊开具了非阿片类镇痛药处方，而在320万（14.22%）次就诊中开具了阿片类镇痛药处方。黑人、年龄在45 - 64岁、居住在农村地区、就诊于医学专科诊所且患有呼吸和消化系统癌症的患者接受阿片类处方的几率更高。
作为门诊环境中针对癌症患者的最大规模疼痛管理研究之一，涵盖4.12亿次患者就诊，我们的研究表明，相当一部分报告有疼痛的癌症患者未获得镇痛药处方，这表明存在疼痛治疗不足的可能性。
疼痛治疗不足仍然是癌症患者一项主要的未满足需求。
