Jairam Vikram, Lindsay Meghan E, Soulos Pamela R, Gross Cary P, Prsic Elizabeth H, Baum Laura V M, Park Henry S
Department of Radiation Oncology (V.J.), Sutter Medical Group, Sacramento, California; Cancer Outcomes (V.J., M.E.L., P.R.S., C.P.G., E.H.P., L.V.M.B., H.S.P.), Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut.
Cancer Outcomes (V.J., M.E.L., P.R.S., C.P.G., E.H.P., L.V.M.B., H.S.P.), Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut.
J Pain Symptom Manage. 2025 Sep;70(3):230-238.e7. doi: 10.1016/j.jpainsymman.2025.05.007. Epub 2025 May 21.
Regulatory efforts in response to the opioid epidemic have resulted in a decrease in opioid prescribing, but their impact on utilization of nonopioid pain medications, pain control, and high-risk opioid use is unknown in patients with and without advanced cancer.
To investigate time trends in opioid use, along with potential associated effects such as gabapentinoid use, pain-related ED visits, and opioid-related encounters, in cancer and non-cancer patients.
We queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from January 01, 2012 to December 31, 2017 to identify patients aged 66 years or older diagnosed with or without advanced solid tumor cancer. The four dependent outcomes assessed were opioid use, gabapentinoid use, pain-related ED visits, and opioid-related encounters within 12 months after the patient's diagnosis or index date. We used multivariable logistic regression models to calculate the predicted probability and temporal change of each outcome for patients with and without cancer.
A total of 294,113 patients were included in the cohort; 45,899 (15.6%) with advanced cancer and 248,214 (84.4%) without cancer. Over the study period, the predicted probability of opioid use declined from 66.0% to 63.5% in the cancer cohort, and from 33.2% to 29.4% in the noncancer cohort, while gabapentinoid use increased in the cancer [9.6%-15.0%] and noncancer [9.0%-13.5%] cohorts (P < 0.01). There was a greater increase in pain-related ED visits [22.3%-29.2%] and opioid-related encounters [0.7%-4.2%] in patients with cancer than among noncancer patients (P < 0.001).
Our findings showed a greater increase in pain-related ED visits and opioid -related encounters among patients with advanced cancer, potentially related to decreases in opioid prescribing, despite a compensatory increase in gabapentinoid use.
应对阿片类药物流行的监管措施已导致阿片类药物处方量减少，但这些措施对患有和未患有晚期癌症患者使用非阿片类止痛药、疼痛控制及高风险阿片类药物使用的影响尚不清楚。
调查癌症患者和非癌症患者阿片类药物使用的时间趋势，以及诸如加巴喷丁类药物使用、与疼痛相关的急诊就诊和与阿片类药物相关的诊疗等潜在相关影响。
我们查询了2012年1月1日至2017年12月31日的监测、流行病学和最终结果（SEER）-医疗保险数据库，以识别66岁及以上被诊断患有或未患有晚期实体肿瘤癌症的患者。评估的四个相关结果是患者诊断或索引日期后12个月内的阿片类药物使用、加巴喷丁类药物使用、与疼痛相关的急诊就诊和与阿片类药物相关的诊疗。我们使用多变量逻辑回归模型计算癌症患者和非癌症患者每种结果的预测概率和时间变化。
该队列共纳入294,113名患者；45,899名（15.6%）患有晚期癌症，248,214名（84.4%）未患癌症。在研究期间，癌症队列中阿片类药物使用的预测概率从66.0%降至63.5%，非癌症队列中从33.2%降至29.4%，而加巴喷丁类药物使用在癌症队列[从9.6%升至15.0%]和非癌症队列[从9.0%升至13.5%]中均有所增加（P<0.01）。与非癌症患者相比，癌症患者中与疼痛相关的急诊就诊[从22.3%升至29.2%]和与阿片类药物相关的诊疗[从0.7%升至4.2%]增加幅度更大（P<0.001）。
我们的研究结果显示，晚期癌症患者中与疼痛相关的急诊就诊和与阿片类药物相关的诊疗增加幅度更大，这可能与阿片类药物处方量减少有关，尽管加巴喷丁类药物使用有所增加作为补偿。
