Opioid Treatment of Pain in People with Cancer: Intended and unintended consequences of state policies addressing opioid prescribing

阿片类药物治疗癌症患者的疼痛：针对阿片类药物处方的国家政策的有意和无意的后果

• 批准号: 10707114
• 负责人: Yuhua Bao
• 金额: $ 38万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707114
• 关键词: Acute Pain; Address; Adult; Affect; American Society of Clinical Oncology; Analgesics; Benefits and Risks; Cancer Pain Management; Cancer Patient; Cancer Survivor; Chills; Chronic; Clinical; Consensus; Coupled; Databases; Disease; Disease remission; Evaluation; Event; Exclusion; Future; Guidelines; Health; Health Insurance; Health Personnel; Health Policy; Hospitals; Indolent; Insurance; International; Intervention; Life Expectancy; Link; Long Term Survivorship; Long-Term Survivors; Machine Learning; Malignant Neoplasms; Maps; Measures; Medicare; Mining; Oncologist; Oncology; Opioid; Outcome; Overdose; Pain; Pain management; Patients; Pattern; Persons; Pharmacy facility; Policies; Policy Maker; Population; Practice Guidelines; Primary Care; Proliferating; Provider; Risk; Specialist; Survivors; Treatment-Related Cancer; active method; advanced disease; anticancer treatment; cancer care; cancer diagnosis; cancer therapy; care coordination; care providers; chronic pain; chronic pain management; clinical development; clinical encounter; dosage; experience; health care service organization; health plan; high risk; innovation; interest; medical specialties; non-cancer chronic pain; non-opioid analgesic; opioid epidemic; opioid policy; opioid therapy; opioid use; patient subsets; prescription monitoring program; prescription opioid; primary care provider; response; therapy development; treatment risk

ABSTRACT Chronic cancer-related pain is highly prevalent and international guidelines have long supported the use of opioid therapy for moderate to severe pain related to active disease. The strength of such consensus is strongest for patients experiencing advanced disease and limited life expectancy. For patients experiencing long-term remission, or, stable or indolent disease without the need for ongoing anti-cancer treatment (“long- term survivorship”), there is emerging consensus that opioid therapies should be addressed in a similar manner as for patients with chronic non-cancer pain. There is mounting ambiguity regarding best practices for patients receiving active anti-cancer treatment intended for cure. In the wake of the opioid epidemic, state policies have proliferated in an effort to reduce unsafe opioid prescribing. Prominent recent policies include state mandates for prescriber participation in the Prescription Drug Monitoring Programs (PDMPs) and state legislative limits on duration and/or dosage of opioid prescriptions for acute pain. These policies vary in their intended applicability to subpopulations of cancer patients, and, coupled with the ambiguity regarding clinical best practices, may have inadvertently impacted opioid use and related outcomes among the different subpopulations of people with cancer. We propose a study to evaluate intended and unintended consequences of the two types of state policies for opioid prescriptions and pain- and opioid-related adverse health events among cancer patients with advanced disease, long-term survivors, and patients receiving active cancer treatment. To help elucidate mechanisms underlying changes in response to policies, we will also explore the trajectories of opioids dispensed and clinical encounters within each subpopulation, using an innovative pattern mining approach. We will use the SEER-Medicare linked database and a large national commercial insurance database to achieve study aims. Findings will inform consensus-building, guideline and intervention development, and policy and practice changes by providers, health care organizations, and policymakers in optimizing opioid prescribing and pain management for cancer patients.

抽象的 慢性癌症相关疼痛非常普遍，国际指南长期以来一直支持使用 阿片类药物治疗与活动性疾病相关的中度至重度疼痛是这种共识的优势。 对于患有晚期疾病和有限预期寿命的患者来说效果最强。 长期缓解，或者稳定或惰性的疾病，无需持续抗癌治疗（“长期 术语“生存”），目前正在形成共识，即阿片类药物治疗应以类似的方式解决 对于患有慢性非癌症疼痛的患者来说，关于最佳实践的模糊性越来越大。 在阿片类药物流行之后，接受积极抗癌治疗的患者。 为了减少不安全的阿片类药物处方，政策不断涌现，最近的重要政策包括。 州要求处方者参与处方药监测计划 (PDMP) 并州 对治疗急性疼痛的阿片类药物处方的持续时间和/或剂量的立法限制这些政策各不相同。 预期适用于癌症患者亚群，并且加上临床方面的模糊性 最佳实践，可能无意中影响了不同人群中阿片类药物的使用和相关结果 我们提出了一项研究来评估预期和非预期后果。 关于阿片类药物处方以及与疼痛和阿片类药物相关的不良健康事件的两类国家政策 晚期癌症患者、长期幸存者和活动性癌症患者 为了帮助阐明应对政策变化的潜在机制，我们还将探讨 使用创新模式了解每个亚群中阿片类药物的分配轨迹和临床遭遇 我们将使用SEER-Medicare链接数据库和大型全国性商业保险。 数据库以实现研究目标，为建立共识、指导方针和干预提供信息。 发展以及医疗保健提供者、医疗保健组织和政策制定者的政策和实践变化 优化癌症患者的阿片类药物处方和疼痛管理。