Baum Laura Van Metre, Soulos Pamela R, Kc Madhav, Jeffery Molly M, Ruddy Kathryn J, Lerro Catherine C, Lee Hana, Graham David J, Rivera Donna R, Liberatore Mark, Leapman Michael S, Jairam Vikram, Dinan Michaela A, Gross Cary P, Park Henry S
Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA.
Cancer. 2025 Oct 1;131(19):e70027. doi: 10.1002/cncr.70027.
Opioid stewardship policies could adversely affect pain management for patients with cancer. Yet patients with cancer are also at risk for opioid-related harms. This study sought to determine trends in opioid prescribing by clinical stratum and pain for patients with cancer from 2016 to 2020.
A retrospective study was conducted of opioid-naive adults with newly diagnosed cancer from 2016 to 2020 (N = 10,232) in a large Connecticut health system. Logistic regression was used to calculate changes in the predicted probability of opioid prescribing from 2016 to 2020. Two subpopulations were examined: patients treated surgically (n = 4405) and patients with metastatic cancer (n = 2158). Flowsheet pain scores for patients with metastatic cancer were used to stratify by no pain (all scores, 0) versus any pain. The main outcomes were new (≥1 prescription in the 0-6 months after diagnosis) and additional (0-6 and 7-9 months) opioid prescriptions.
A decline was observed in the predicted probability of new (71.1% to 64.6%; p < .001) and additional prescribing (27.2% to 24.2%; p = .07 [not significant]) declined. Among surgical patients, the predicted probability of new opioid prescribing fell (96.0% to 88.6%; p < .001), whereas additional prescribing was stable (13%). For patients with metastatic cancer with pain, new opioid prescribing was stable (56%). For those reporting no pain, the predicted probability of new opioid prescribing declined from 61.6% to 36.1% (p < .001).
In the context of widespread policy changes, this study showed a modest decline in new and additional opioid prescribing for patients with cancer. In metastatic cancer, prescribing remained stable for patients reporting pain and declined steeply for those reporting no pain.
阿片类药物管理政策可能会对癌症患者的疼痛管理产生不利影响。然而，癌症患者也面临阿片类药物相关危害的风险。本研究旨在确定2016年至2020年癌症患者按临床分层和疼痛情况的阿片类药物处方趋势。
对2016年至2020年在康涅狄格州一个大型医疗系统中初诊为癌症且未使用过阿片类药物的成年患者（N = 10232）进行回顾性研究。采用逻辑回归分析计算2016年至2020年阿片类药物处方预测概率的变化。研究了两个亚组：接受手术治疗的患者（n = 4405）和转移性癌症患者（n = 2158）。转移性癌症患者的流程表疼痛评分用于按无疼痛（所有评分均为0）与有任何疼痛进行分层。主要结局为新的（诊断后0至6个月内≥1次处方）和额外的（0至6个月和7至9个月）阿片类药物处方。
新处方（71.1%降至64.6%；p <.001）和额外处方（27.2%降至24.2%；p =.07[无统计学意义]）的预测概率均下降。在手术患者中，新阿片类药物处方的预测概率下降（96.0%降至88.6%；p <.001），而额外处方稳定（13%）。对于有疼痛的转移性癌症患者，新阿片类药物处方稳定（56%）。对于报告无疼痛的患者，新阿片类药物处方的预测概率从61.6%降至36.1%（p <.001）。
在广泛的政策变化背景下，本研究显示癌症患者新的和额外的阿片类药物处方略有下降。在转移性癌症中，报告有疼痛的患者处方保持稳定，而报告无疼痛的患者处方急剧下降。
