居家临终关怀的癌症终末期患者中潜在不适当的处方

Potentially Inappropriate Prescriptions in End-of-Life Cancer Patients in Home-Based Hospice Care.

作者信息

Lee Junyong, Lee Chung-Woo, Kim Hwa Sun, Kim Hak Ryeong, Lim Soo Yun, Kim Jung Ran

机构信息

Hospice & Palliative Care Center (J.L., C.W.L., S.Y.L., J.R.K.), Veterans Health Service Medical Center, Gangdong-gu, Seoul, Republic of Korea; Department of Family Medicine (J.L., C.W.L., H.S.K., H.R.K., S.Y.L., J.R.K.), Veterans Health Service Medical Center, Gangdong-gu, Seoul, Republic of Korea.

出版信息

J Pain Symptom Manage. 2025 Jul;70(1):22-29. doi: 10.1016/j.jpainsymman.2025.03.021. Epub 2025 Mar 25.

DOI:10.1016/j.jpainsymman.2025.03.021

PMID:40147504

Abstract

CONTEXT

Polypharmacy and inappropriate prescribing are prevalent among end-of-life cancer patients, potentially compromising symptom management and quality of life. Limited data are available on potentially inappropriate medications (PIMs) and prescribing omissions (PPOs) of opioid in South Korea, particularly in home-based hospice care settings.

OBJECTIVES

This study aimed to evaluate the prevalence of PIMs and PPOs in advanced cancer patients referred to home-based hospice care and identify factors associated with these prescribing issues.

METHODS

A retrospective observational study included 102 advanced cancer patients referred to a single center's home-based hospice care between November 2022 and November 2023. PIMs were assessed using the STOPPFrail criteria, while PPOs were defined as inadequate opioid prescribing omissions for moderate to severe cancer pain. Logistic regression analysis identified factors associated with PIMs and PPOs.

RESULTS

PIMs were observed in 40.2% of patients, with higher prevalence in those over 70 years old (48.7%) and those with multiple comorbidities. Statins (25.5%) and antihypertensives (29.4%) were the most common PIMs. Among patients with moderate to severe cancer pain, 45.5% experienced PPOs due to inadequate opioid prescriptions. Older age (OR 3.90, P < 0.01) and comorbidities (OR 20.90, p < 0.01) were significantly associated with PIMs, while diabetes was linked to PPOs (OR 2.00, P = 0.01).

CONCLUSION

The findings highlight critical gaps in medication management for end-of-life cancer patients. Systematic deprescribing protocols and improved strategies to address opioid stigma and prescribing hesitancy are essential to align treatments with end-of-life care goals and enhance patient quality of life.

摘要

背景

多重用药和不适当处方在临终癌症患者中很普遍，可能会影响症状管理和生活质量。关于韩国潜在不适当药物（PIMs）和阿片类药物处方遗漏（PPOs）的数据有限，尤其是在居家临终关怀环境中。

目的

本研究旨在评估转诊至居家临终关怀的晚期癌症患者中PIMs和PPOs的患病率，并确定与这些处方问题相关的因素。

方法

一项回顾性观察研究纳入了2022年11月至2023年11月间转诊至单一中心居家临终关怀的102例晚期癌症患者。使用STOPPFrail标准评估PIMs，而PPOs被定义为中度至重度癌症疼痛的阿片类药物处方不足。逻辑回归分析确定了与PIMs和PPOs相关的因素。

结果

40.2%的患者存在PIMs，70岁以上患者（48.7%）和患有多种合并症的患者患病率更高。他汀类药物（25.5%）和抗高血压药物（29.4%）是最常见的PIMs。在中度至重度癌症疼痛患者中，45.5%因阿片类药物处方不足而出现PPOs。年龄较大（OR 3.90，P < 0.01）和合并症（OR 20.90，p < 0.01）与PIMs显著相关，而糖尿病与PPOs相关（OR 2.00，P = 0.01）。