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首页> 外文期刊>Pain. >Opioid prescribing for patients with cancer in the last year of life: a longitudinal population cohort study
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Opioid prescribing for patients with cancer in the last year of life: a longitudinal population cohort study

机译：阿片类药物为生命最后一年的癌症患者开药：一项纵向人群队列研究

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We linked UK cancer registry data with the corresponding electronic primary care medical records of 6080 patients who died of cancer over a 7-year period in a large United Kingdom city. We extracted all prescriptions for analgesics issued to each patient in the linked cohort during the 12 months before death and analysed the extent and duration of strong opioid treatment with clinical and patient characteristics. Strong opioids were prescribed for 48% of patients in the last year of life. Median interval between first prescription of a strong opioid and death was 9 weeks (interquartile range 3-23). Strong opioid prescribing was not influenced by cancer type, duration of illness, or gender but was adversely influenced by older age. Compared with patients who died in a hospice, those who died in a hospital were 60% less likely to receive a strong opioid in primary care before admission (relative risk ratio 0.4, CI 0.3-0.5, P < 0.01). The study provides the first detailed analysis of the relatively late onset and short duration of strong opioid treatment in patients with cancer before death in a representative UK cohort. This pattern of prescribing does not match epidemiological data which point to earlier onset of pain. Although persistent undertreatment of cancer pain is well documented, this study suggests that strategies for earlier pain assessment and initiation of strong opioid treatment in community-based patients with cancer could help to improve pain outcomes.
机译：我们将英国的癌症登记数据与相应的电子基层医疗医疗记录相关联，这些数据在英国的一个大城市中，在7年的时间里死于6080名癌症患者。我们提取了在死亡前12个月内向相关队列中的每位患者颁发的所有镇痛药处方，并分析了具有临床和患者特征的强效阿片类药物治疗的程度和持续时间。在生命的最后一年中，为48％的患者开了强效阿片类药物。首次服用强阿片类药物与死亡之间的中位间隔为9周（四分位间距3-23）。强烈的阿片类药物处方不受癌症类型，疾病持续时间或性别的影响，但受年龄较大的影响。与死于临终关怀的患者相比，死于医院的患者在入院前接受强效阿片类药物治疗的可能性要低60％（相对危险度比为0.4，CI为0.3-0.5，P <0.01）。该研究首次对英国代表性队列中死亡前癌症患者接受强阿片类药物治疗的相对较晚发作和较短持续时间进行了首次详细分析。这种处方方式与流行病学数据不符，后者表明疼痛较早发作。尽管有充分的文献证明对癌症疼痛的持续治疗不足，但这项研究表明，针对以社区为基础的癌症患者进行早期疼痛评估和开始强力阿片类药物治疗的策略可以帮助改善疼痛预后。

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