Hannah Harsanyi, Lin Yang, Jenny Lau, Winson Y Cheung, Yuan Xu, Colleen Cuthbert
{"title":"转移性癌症的长期阿片类药物处方和保健遭遇：观察性人群研究","authors":"Hannah Harsanyi, Lin Yang, Jenny Lau, Winson Y Cheung, Yuan Xu, Colleen Cuthbert","doi":"10.1136/spcare-2024-005185","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although opioids are effective for cancer pain management, long-term use may result in adverse effects which are understudied among patients with metastatic disease.</p><p><strong>Objectives: </strong>To describe long-term opioid prescribing among patients with metastatic cancer and investigate how long-term prescribing practices are associated with the incidence of opioid-related hospitalisations and emergency department visits.</p><p><strong>Methods: </strong>This retrospective cohort study included all opioid-naïve patients diagnosed with solid metastatic cancer in Alberta, Canada from 2004 to 2017 who had ≥1 year of follow-up. Patients were identified and followed using linked administrative health data. Long-term prescribing was defined as receiving a ≥90-day supply of opioids with a <30-day gap in supply within a 180-day period. The incidence rate of opioid-related healthcare encounters was compared based on characteristics of long-term prescribing (timing, dosage, duration and concurrent medications).</p><p><strong>Results: </strong>The study included 10 927 patients, 2521 (23%) of whom received long-term opioid prescribing. These practices became more common near the end of life, with 53% of cases initiated during patients' last year of life. Opioid-related healthcare encounters were experienced by 85 (3.4%) recipients of long-term prescribing. Higher dosage (p<0.001) and concurrent prescribing of anxiolytics (p=0.001), benzodiazepines (p=0.001), antidepressants (p=0.027) and neuroleptics (p<0.001) were associated with a higher incidence of opioid-related healthcare encounters.</p><p><strong>Conclusions: </strong>Long-term opioid prescribing is common, and patients receiving long-term prescriptions with high dosage or concurrent psychoactive medications may benefit from interventions aimed at reducing opioid-related adverse effects. Further research is needed to determine strategies to minimise opioid-related harms for these patients while providing appropriate pain and symptom management.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term opioid prescribing and healthcare encounters in metastatic cancer: observational population study.\",\"authors\":\"Hannah Harsanyi, Lin Yang, Jenny Lau, Winson Y Cheung, Yuan Xu, Colleen Cuthbert\",\"doi\":\"10.1136/spcare-2024-005185\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although opioids are effective for cancer pain management, long-term use may result in adverse effects which are understudied among patients with metastatic disease.</p><p><strong>Objectives: </strong>To describe long-term opioid prescribing among patients with metastatic cancer and investigate how long-term prescribing practices are associated with the incidence of opioid-related hospitalisations and emergency department visits.</p><p><strong>Methods: </strong>This retrospective cohort study included all opioid-naïve patients diagnosed with solid metastatic cancer in Alberta, Canada from 2004 to 2017 who had ≥1 year of follow-up. Patients were identified and followed using linked administrative health data. Long-term prescribing was defined as receiving a ≥90-day supply of opioids with a <30-day gap in supply within a 180-day period. The incidence rate of opioid-related healthcare encounters was compared based on characteristics of long-term prescribing (timing, dosage, duration and concurrent medications).</p><p><strong>Results: </strong>The study included 10 927 patients, 2521 (23%) of whom received long-term opioid prescribing. These practices became more common near the end of life, with 53% of cases initiated during patients' last year of life. Opioid-related healthcare encounters were experienced by 85 (3.4%) recipients of long-term prescribing. Higher dosage (p<0.001) and concurrent prescribing of anxiolytics (p=0.001), benzodiazepines (p=0.001), antidepressants (p=0.027) and neuroleptics (p<0.001) were associated with a higher incidence of opioid-related healthcare encounters.</p><p><strong>Conclusions: </strong>Long-term opioid prescribing is common, and patients receiving long-term prescriptions with high dosage or concurrent psychoactive medications may benefit from interventions aimed at reducing opioid-related adverse effects. Further research is needed to determine strategies to minimise opioid-related harms for these patients while providing appropriate pain and symptom management.</p>\",\"PeriodicalId\":9136,\"journal\":{\"name\":\"BMJ Supportive & Palliative Care\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-03-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Supportive & Palliative Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/spcare-2024-005185\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Supportive & Palliative Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/spcare-2024-005185","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Long-term opioid prescribing and healthcare encounters in metastatic cancer: observational population study.
Background: Although opioids are effective for cancer pain management, long-term use may result in adverse effects which are understudied among patients with metastatic disease.
Objectives: To describe long-term opioid prescribing among patients with metastatic cancer and investigate how long-term prescribing practices are associated with the incidence of opioid-related hospitalisations and emergency department visits.
Methods: This retrospective cohort study included all opioid-naïve patients diagnosed with solid metastatic cancer in Alberta, Canada from 2004 to 2017 who had ≥1 year of follow-up. Patients were identified and followed using linked administrative health data. Long-term prescribing was defined as receiving a ≥90-day supply of opioids with a <30-day gap in supply within a 180-day period. The incidence rate of opioid-related healthcare encounters was compared based on characteristics of long-term prescribing (timing, dosage, duration and concurrent medications).
Results: The study included 10 927 patients, 2521 (23%) of whom received long-term opioid prescribing. These practices became more common near the end of life, with 53% of cases initiated during patients' last year of life. Opioid-related healthcare encounters were experienced by 85 (3.4%) recipients of long-term prescribing. Higher dosage (p<0.001) and concurrent prescribing of anxiolytics (p=0.001), benzodiazepines (p=0.001), antidepressants (p=0.027) and neuroleptics (p<0.001) were associated with a higher incidence of opioid-related healthcare encounters.
Conclusions: Long-term opioid prescribing is common, and patients receiving long-term prescriptions with high dosage or concurrent psychoactive medications may benefit from interventions aimed at reducing opioid-related adverse effects. Further research is needed to determine strategies to minimise opioid-related harms for these patients while providing appropriate pain and symptom management.
期刊介绍：
Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance.
We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication.
In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.
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