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
{"title":"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","authors":"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","doi":"10.1002/cncr.70027","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective study was conducted of opioid-naive adults with newly diagnosed cancer from 2016 to 2020 (<i>N</i> = 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 (<i>n</i> = 4405) and patients with metastatic cancer (<i>n</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A decline was observed in the predicted probability of new (71.1% to 64.6%; <i>p</i> < .001) and additional prescribing (27.2% to 24.2%; <i>p</i> = .07 [not significant]) declined. Among surgical patients, the predicted probability of new opioid prescribing fell (96.0% to 88.6%; <i>p</i> < .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% (<i>p</i> < .001).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 19","pages":""},"PeriodicalIF":5.1000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.70027","citationCount":"0","resultStr":"{\"title\":\"Opioid prescribing trends and pain scores among adult patients with cancer in a large health system\",\"authors\":\"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. 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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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A decline was observed in the predicted probability of new (71.1% to 64.6%; <i>p</i> < .001) and additional prescribing (27.2% to 24.2%; <i>p</i> = .07 [not significant]) declined. Among surgical patients, the predicted probability of new opioid prescribing fell (96.0% to 88.6%; <i>p</i> < .001), whereas additional prescribing was stable (13%). For patients with metastatic cancer with pain, new opioid prescribing was stable (56%). 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Opioid prescribing trends and pain scores among adult patients with cancer in a large health system
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.
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
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