Improvement in patient-reported pain among patients with metastatic cancer and its association with opioid prescribing.

Autor: Harsanyi H; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada. hannah.harsanyi@ucalgary.ca., Yang L; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.; Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada., Harper A; Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada., Jarada TN; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., Quan ML; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., Cheung WY; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., Lupichuk S; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., Cuthbert C; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.; Faculty of Nursing, University of Calgary, Calgary, AB, Canada., Xu Y; Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, HRIC 2AA18, 3230, Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; The Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Jazyk: angličtina
Zdroj: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2023 Jun 28; Vol. 31 (7), pp. 427. Date of Electronic Publication: 2023 Jun 28.
DOI: 10.1007/s00520-023-07893-2
Abstrakt: Purpose: Opioids are a mainstay of cancer pain management; however, patients with metastatic cancer are often excluded from studies, leading to a lack of evidence on whether increased prescribing (dosage and/or duration) results in improved outcomes for this population. This study aimed to investigate whether increased opioid prescribing is associated with an improvement in patient-reported pain among patients with metastatic cancer.
Patients and Methods: A retrospective cohort of all adult patients diagnosed with stage IV cancers, who completed at least two patient-reported outcomes (PROs) within 30 days of each other, was identified from administrative data. Opioid prescriptions were categorized by dosage level and number of prescription days. Multivariable logistic regression was used to investigate the association between opioid prescribing and clinically important improvement in pain score (≥ 1 point change on the Edmonton Symptom Assessment System).
Results: A total of 2169 patients were included, 770 (35.5%) of whom had active opioid prescription between PROs, with an average daily dosage of 86.1 mg of oral morphine equivalent. Active prescription was associated with improvement in pain (OR = 2.17, P < 0.001). However, among patients with active prescription, neither dosage nor number of prescription days was significantly associated with pain improvement.
Conclusion: Opioid prescription is important for treating cancer-related pain; however, increased dosage or duration may not be leading to greater improvements in pain. Patients with metastatic cancer who are receiving increased opioid prescribing may have difficult-to-treat pain and may benefit from multidisciplinary pain management strategies to supplement opioid prescription and improve outcomes.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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