Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Department of Statistics, Seoul National University, Seoul, South Korea.
Cancer Med. 2024 Oct;13(20):e70211. doi: 10.1002/cam4.70211.
Understanding factors associated with opioid dispensing in cancer patients is important for developing tailored guidelines and ensuring equitable access to pain management. We examined patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015.
We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims. We included the most common cancer types among patients aged 66-95 years. Opioids dispensed within 30 days before and 120 days after cancer diagnosis were assessed. We used logistic regression models to examine trends, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) for opioid dispensing, considering patient demographics, geography, cancer stage, comorbidities, and treatment options. Models were stratified by sex.
A total of 211,759 cancer patients aged 66-95 years were included in the study. For cancers combined, non-Hispanic Black men had a significantly lower odds of receiving opioids during the 120 days post-diagnosis (aOR = 0.89, 95% CI = 0.84-0.94) compared to non-Hispanic White men. Factors such as pre-diagnosis opioid dispensing, age, geography, cancer stage, comorbidities, and type of cancer treatment were associated with opioid dispensing during the 120 days post-diagnosis. Surgery had the strongest association, with men undergoing surgery being 4.4 times more likely to receive opioids within 120 days post-diagnosis (aOR = 4.41, 95% CI = 4.23-4.60), while women had an odds ratio of 2.72 (95% CI = 2.62-2.83). Chemotherapy and radiotherapy were also positively associated with opioid dispensing, with less pronounced estimates.
We observed significant variations in opioid dispensing among cancer patients aged 66-95 years across cancer types and demographic and clinical factors.
了解与癌症患者阿片类药物配给相关的因素对于制定针对性的指南和确保公平获得疼痛管理至关重要。我们研究了 2008 年至 2015 年间老年癌症患者阿片类药物配给的模式和预测因素。
我们分析了来自监测、流行病学和最终结果 (SEER) 数据库与医疗保险索赔相关的数据。我们纳入了年龄在 66-95 岁之间的患者中最常见的癌症类型。评估了癌症诊断前 30 天和诊断后 120 天内开出的阿片类药物。我们使用逻辑回归模型研究趋势，调整后的优势比 (aOR) 和 95%置信区间 (CI)，以考虑患者的人口统计学、地理位置、癌症分期、合并症和治疗选择，模型按性别分层。
共有 211759 名年龄在 66-95 岁的癌症患者纳入研究。对于所有癌症，与非西班牙裔白人男性相比，非西班牙裔黑人男性在诊断后 120 天内接受阿片类药物的可能性显著降低 (aOR=0.89，95%CI=0.84-0.94)。在诊断后 120 天内开出阿片类药物与预诊断阿片类药物的配给、年龄、地理位置、癌症分期、合并症和癌症治疗类型等因素有关。手术具有最强的相关性，接受手术的男性在诊断后 120 天内接受阿片类药物的可能性是未接受手术男性的 4.4 倍 (aOR=4.41，95%CI=4.23-4.60)，而女性的比值比为 2.72(95%CI=2.62-2.83)。化疗和放疗也与阿片类药物的配给呈正相关，但估计值不那么明显。
我们观察到 66-95 岁癌症患者在不同癌症类型和人口统计学及临床因素方面的阿片类药物配给存在显著差异。
