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IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association Pub Date : 2025-02-24 DOI:10.1016/j.jamda.2025.105522

Yu-Jung Jenny Wei, Almut G Winterstein, Siegfried Schmidt, Roger B Fillingim, Stephan Schmidt, Michael J Daniels, Steven T DeKosky, Henry Young, Ting-Yuan David Cheng

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引用次数: 0

摘要

目的：由于有关长期阿片类药物治疗的风险和益处的证据有限，因此临床决定是否继续或停止对老年癌症幸存者的长期阿片类药物治疗（LTOT；≥3个月）仍具有挑战性。本研究旨在探讨在长期护理（LTC）环境中居住的老年癌症幸存者停止长期阿片治疗与临床和阿片相关不良事件（ORAE）结果之间的关联：这项回顾性队列研究分析了 2010 年至 2021 年期间来自 100%医疗保险养老院样本的数据：环境和参与者：年龄≥65 岁的长期护理（LTC）住院患者，他们是至少 1 年的癌症幸存者，因慢性疼痛接受过 LTOT 治疗：停用 LTOT 的定义是至少 90 天内未重新开具阿片类药物处方。临床结果包括疼痛恶化、身体功能和抑郁；ORAE 结果包括疼痛相关住院次数、疼痛相关急诊就诊次数、阿片类药物使用障碍和阿片类药物过量。我们对临床结果使用了修正泊松模型，对ORAE结果使用了泊松模型，并通过逆治疗概率加权调整了基线协变量：在21861例接受LTOT治疗的癌症幸存者中，18984名幸存者（86.8%）继续接受LTOT治疗，而2877名幸存者（13.2%）中断了LTOT治疗。停药者与继续用药者相比，疼痛恶化的调整风险较低（相对风险为 0.65，95% CI 为 0.59-0.74，P < .001），阿片类药物使用障碍的调整率较低（比率比为 0.76，95% CI 为 0.64-0.90，P < .001），阿片类药物过量的调整率较低（比率比为 0.33，95% CI 0.21-0.52，P < .001），身体功能和抑郁症状以及疼痛相关的住院率和急诊就诊率没有差异：停用 LTOT 与继续 LTOT 相比，疼痛恶化、阿片类药物使用障碍和阿片类药物过量的风险较低，其他研究结果的风险无差异。在老年 LTC 癌症幸存者中，停用 LTOT 与继续 LTOT 的益处可能大于风险。

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Outcomes of Discontinuing Long-Term Opioid Therapy Among Older Cancer Survivors in Long-Term Care Settings.

Objectives: 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.

Designs: This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.

Setting and participants: LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.

Methods: 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.

Results: 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.

Conclusions and implications: 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.

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality