O'Regan Amy, Lee Jeehye Rose, McDermott Cara L, Cohen Harvey Jay, Merlin Jessica S, Marais Andrea Des, Winn Aaron N, Meghani Salimah H, Check Devon K
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
Duke University Trinity College of Arts and Sciences, Durham, NC, United States.
J Geriatr Oncol. 2025 Mar;16(2):102172. doi: 10.1016/j.jgo.2024.102172. Epub 2024 Dec 14.
Opioids and benzodiazepines are commonly prescribed for cancer symptoms. In combination, they can increase the risk of adverse events, particularly for older adults with multimorbidity, who represent most patients with cancer. We aimed to understand cancer care providers' practices for opioid and benzodiazepine coprescribing and mitigating potential harms.
We interviewed oncology and palliative care providers from two health systems. Interviews focused on attitudes about and current practices for coprescribing opioids and benzodiazepines. We analyzed interview transcripts using a staged approach to thematic analysis.
Twenty providers (10 oncology, 10 palliative care) participated. We identified three key themes. (1) Reluctance to prescribe benzodiazepines: providers reported rarely coprescribing because they do not routinely prescribe benzodiazepines, which were viewed as having a poor safety profile. (2) Medication safety precautions: these included starting at a low dose and titrating up slowly, consolidating prescriptions under one provider whenever possible, and providing patient and caregiver education around side effects, overdose, and naloxone. Compared to oncologists, palliative care providers more often described providing naloxone to patients and caregivers. (3) Risk assessment and monitoring: most providers mentioned checking state Prescription Drug Monitoring Program databases and conducting chart reviews to identify evidence of substance misuse history. Several oncologists expressed discomfort in asking about substance misuse history due to concerns about stigma. Providers described sometimes relying on their perception of a patient's trustworthiness, with some acknowledging the potential for bias.
We highlight opportunities to improve medication review and reconciliation practices in oncology, increase uptake of naloxone in oncology practice, systematize efforts to screen patients for substance misuse, and strengthen integration of addiction and psychiatry services into oncology and palliative care settings. Regular use of geriatric assessment in oncology would also address many of the safety concerns we observed.
阿片类药物和苯二氮䓬类药物常用于治疗癌症症状。两者联合使用会增加不良事件的风险，对于患有多种疾病的老年人来说尤其如此，而这些老年人占大多数癌症患者。我们旨在了解癌症护理提供者联合开具阿片类药物和苯二氮䓬类药物的做法以及减轻潜在危害的措施。
我们采访了来自两个医疗系统的肿瘤学和姑息治疗提供者。访谈重点围绕联合开具阿片类药物和苯二氮䓬类药物的态度及当前做法。我们采用分阶段的主题分析法对访谈记录进行分析。
20名提供者（10名肿瘤学提供者、10名姑息治疗提供者）参与了研究。我们确定了三个关键主题。（1）不愿开具苯二氮䓬类药物：提供者报告称很少联合开具此类药物，因为他们通常不开具苯二氮䓬类药物，认为其安全性不佳。（2）药物安全预防措施：包括低剂量起始并缓慢滴定、尽可能由同一提供者合并处方，以及围绕副作用、过量用药和纳洛酮对患者及护理者进行教育。与肿瘤学家相比，姑息治疗提供者更常描述为患者及护理者提供纳洛酮。（3）风险评估与监测：大多数提供者提到会查看州处方药监测计划数据库并进行病历审查，以识别药物滥用史的证据。几位肿瘤学家因担心污名化而对询问药物滥用史表示不适。提供者描述有时会依赖他们对患者可信度的判断，一些人承认存在偏见的可能性。
我们强调了改善肿瘤学药物审查与核对做法、增加肿瘤学实践中纳洛酮的使用、系统化筛查患者药物滥用情况的工作，以及加强将成瘾和精神病学服务纳入肿瘤学和姑息治疗环境的机会。在肿瘤学中定期使用老年评估也将解决我们观察到的许多安全问题。
