Wei Yu-Jung Jenny, Winterstein Almut G, Schmidt Siegfried, Fillingim Roger B, Schmidt Stephan, Daniels Michael J, DeKosky Steven T, Young Henry, Cheng Ting-Yuan David
Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA.
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA; Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA.
J Am Med Dir Assoc. 2025 Apr;26(4):105522. doi: 10.1016/j.jamda.2025.105522. Epub 2025 Mar 6.
Clinical decisions to continue or discontinue long-term opioid therapy (LTOT; ≥3 months) for older cancer survivors remain challenging due to limited evidence on the risks and benefits of this treatment practice. This study aims to examine the associations of discontinuing LTOT with clinical and opioid-related adverse event (ORAE) outcomes among older cancer survivors residing in long-term care (LTC) settings.
This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.
LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.
Discontinuation of LTOT was defined as no prescription opioid refills for at least 90 days. Clinical outcomes included worsening pain, physical function, and depression; ORAE outcomes included counts of pain-related hospitalizations, pain-related emergency department visits, opioid use disorder, and opioid overdose. We used modified Poisson models for clinical outcomes and Poisson models for ORAE outcomes, adjusting baseline covariates via inverse probability of treatment weighting.
Of 21,861 episodes of cancer survivors with LTOT, 18,984 survivors (86.8%) continued LTOT, whereas 2877 survivors (13.2%) discontinued LTOT. The discontinuers vs continuers had lower adjusted risk of worsening pain (relative risk 0.65, 95% CI 0.59-0.74, P < .001) and lower adjusted rates of opioid use disorder (rate ratio 0.76, 95% CI 0.64-0.90, P < .001) and opioid overdose (rate ratio 0.33, 95% CI 0.21-0.52, P < .001) at the 1-year follow-up, with no difference in physical function and depressive symptoms or rates of pain-related hospitalizations and emergency department visits.
Discontinuing vs continuing LTOT was associated with lower risk of worsening pain, opioid use disorder, and opioid overdose, with nondifferential risks of the other studied outcomes. Discontinuing vs continuing LTOT may confer benefits that outweigh risks among older LTC cancer survivors.
由于长期阿片类药物治疗（LTOT；≥3个月）对老年癌症幸存者的风险和益处的证据有限，因此对于老年癌症幸存者而言，决定继续或停止LTOT仍然具有挑战性。本研究旨在探讨在长期护理（LTC）机构中居住的老年癌症幸存者中，停止LTOT与临床及阿片类药物相关不良事件（ORAE）结局之间的关联。
这项回顾性队列研究分析了2010年至2021年100%医疗保险疗养院样本中的数据。
年龄≥65岁、癌症存活至少1年且因慢性疼痛接受LTOT的LTC居民。
LTOT的停止定义为至少90天没有阿片类药物处方续配。临床结局包括疼痛加剧、身体功能和抑郁情况；ORAE结局包括与疼痛相关的住院次数、与疼痛相关的急诊科就诊次数、阿片类药物使用障碍和阿片类药物过量。我们对临床结局使用改良泊松模型，对ORAE结局使用泊松模型，并通过治疗权重的逆概率调整基线协变量。
在21,861例接受LTOT的癌症幸存者中，18,984例幸存者（86.8%）继续LTOT，而2877例幸存者（13.2%）停止LTOT。在1年随访时，与继续使用者相比，停止使用者疼痛加剧的调整后风险较低（相对风险0.65，95%CI 0.59 - 0.74，P <.001），阿片类药物使用障碍的调整率较低（率比0.76，95%CI 0.64 - 0.90，P <.001），阿片类药物过量的调整率较低（率比0.33，95%CI 0.21 - 0.52，P <.001），身体功能和抑郁症状或与疼痛相关的住院和急诊科就诊率没有差异。
与继续LTOT相比，停止LTOT与疼痛加剧、阿片类药物使用障碍和阿片类药物过量的风险较低相关，而其他研究结局的风险无差异。对于老年LTC癌症幸存者，停止LTOT与继续LTOT相比可能带来的益处大于风险。
