Opioid prescribing trends and pain scores among adult patients with cancer in a large health system

IF 5.1 2区医学 Q1 ONCOLOGY

Cancer Pub Date : 2025-09-22 DOI:10.1002/cncr.70027

Laura Van Metre Baum MD, MPH, Pamela R. Soulos MPH, Madhav KC PhD, MPH, Molly M. Jeffery PhD, Kathryn J. Ruddy MD, MPH, Catherine C. Lerro PhD, MPH, Hana Lee PhD, David J. Graham MD, MPH, Donna R. Rivera PharmD, MSc, Mark Liberatore PharmD, RAC, Michael S. Leapman MD, MHS, Vikram Jairam MD, Michaela A. Dinan PhD, Cary P. Gross MD, Henry S. Park MD, MPH

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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大型卫生系统中成年癌症患者的阿片类药物处方趋势和疼痛评分

阿片类药物管理政策可能对癌症患者的疼痛管理产生不利影响。然而，癌症患者也面临着阿片类药物相关危害的风险。本研究旨在确定2016年至2020年癌症患者按临床阶层和疼痛开具阿片类药物处方的趋势。方法回顾性研究2016 - 2020年康涅狄格洲大型卫生系统中未使用阿片类药物的新诊断癌症成人患者（N = 10232）。采用Logistic回归计算2016 - 2020年阿片类药物处方预测概率的变化。两个亚群被检查：接受手术治疗的患者（n = 4405）和转移性癌症患者（n = 2158）。转移性癌症患者的疼痛量表评分用于无疼痛（所有评分均为0）和有疼痛的分层。主要结果为新开阿片类药物（诊断后0-6个月≥1张）和额外（0-6个月和7-9个月）。结果预测新发概率（71.1% ~ 64.6%,p < .001）和补充处方概率（27.2% ~ 24.2%,p = .07[无统计学意义]）下降。在手术患者中，新的阿片类药物处方的预测概率下降（96.0%至88.6%;p < .001），而额外的处方是稳定的（13%）。对于伴有疼痛的转移性癌症患者，新的阿片类药物处方是稳定的（56%）。对于那些报告没有疼痛的患者，新的阿片类药物处方的预测概率从61.6%下降到36.1% （p < .001）。在广泛政策变化的背景下，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，报告疼痛的患者的处方保持稳定，而报告无疼痛的患者的处方则急剧下降。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer 医学-肿瘤学

CiteScore

13.10

自引率

3.20%

发文量

480

审稿时长

2-3 weeks

期刊介绍： The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research