The Role of Opioid Adherence Profiles in Cancer Pain Self-Management and Outcomes

阿片类药物依从性在癌痛自我管理和结果中的作用

• 批准号: 10112312
• 负责人: Salimah H. Meghani
• 金额: $ 54.15万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-25 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10112312
• 关键词: Accident and Emergency department; Address; Adherence; African American; Age; American; Analgesics; Area; Attention; Belief; Breakthrough Pain; Cancer Pain Management; Cancer Patient; Cancer Science; Caring; Clinical; Complementary and alternative medicine; Constipation; Data; Dose; Drug Prescriptions; Event; Exclusion Criteria; Flare; Health Services; Healthcare; Hospitalization; Human; Individual; Intervention; Knowledge; Longitudinal Studies; Love; Malignant Neoplasms; Monitor; National Institute of Nursing Research; Oncology; Opioid; Opioid Analgesics; Outcome; Outpatients; Pain; Pain Research; Pain management; Patient Outcomes Assessments; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Policies; Prospective cohort study; Public Health; Quality of life; Race; Reporting; Research; Role; Schedule; Self Management; Services; Severities; Side; Symptoms; System; Testing; Time; United States National Institutes of Health; Woman; addiction; base; cancer diagnosis; cancer pain; cancer therapy; chronic pain; clinical predictors; cost; daily pain; design; disparity reduction; experience; health care service utilization; health disparity; health management; health related quality of life; improved; knowledge translation; non-opioid analgesic; opioid misuse; opioid therapy; opioid use; pain self-management; prescription opioid; racial disparity; recruit; sex; side effect; sleep health; sociodemographics; socioeconomics; systematic review; therapy development; time use

ABSTRACT/ PROJECT SUMMARY Pain is one of the top symptoms producing the greatest negative impact on cancer patients' quality of life. Unfortunately, one in three cancer patients will experience moderate to severe pain due to consequences of cancer, its treatments or both. For one in three, pain will persist after completion of active cancer treatments. With 15.5 million Americans living with cancer, this is a substantial public health matter. While many complementary and alternative medicine approaches exist, their clinical use for cancer pain remains seriously hampered by lack of robust evidence, short-term relief, and excessive out-of-pocket costs. In turn, opioid pain medications are prescribed to cancer patients – who notably, also remain excluded from most state and policy initiatives on opioids. Long-term (>3 months ) opioid therapy is also prevalent among cancer outpatients when compared to age-sex matched controls. Despite this, cancer patients have been almost invariably excluded from T he recent Health management” studies investigating the outcomes of long-term opioid therapy and use. and Human Services Pain Management Inter-Agency Taskforce has identified “self- as one of the best practices in improving chronic pain. However,interventions cannot be designed due to serious gaps in our current understanding of cancer outpatients' pain self-management and especially their opioid self-management. Recent systematic reviews demonstrate that most cancer pain interventions (based on knowledge translation and conducted predominantly or exclusively with White patients) improve knowledge, but largely do not improve outcomes that matter to patients such as daily pain, function, or quality of life. This underscores a need to continue in search of other targets for intervention development. This 6-month prospective cohort study will generate new knowledge about longitudinal pain, opioid self- management trajectories, and associated outcomes among cancer outpatients in the context of daily pain, pain flares, key clinical moderators and covariates. A total of 400 cancer outpatients (50% African Americans; 50% women) who are prescribed long-acting (LA) opioids will be recruited from three urban oncology centers. Longitudinal opioid self-management patterns will be captured in real-time using medication event monitoring system (MEMS®). Daily background pain, pain flares, and use of “as-needed” opioids will be collected using the self-report tracker (SRT®). Patient-reported outcomes (PRO) to be assessed are changes in pain levels, function, sleep, and health-related quality of life. Health services outcomes include unplanned hospitalizations and emergency department use (healthcare utilization). This study will supply rigorous data, comprehensive set of sociodemographic and clinical covariates, and key moderators upon which further research for pain-self management best practices can be based, including targets to ameliorate racial disparities. Overall, this research can have a sustained impact on the science of cancer pain management.

摘要/项目摘要 疼痛是对癌症患者生活质量产生最大负面影响的最大症状之一。 不幸的是，由于后果，三分之一的癌症患者会因 癌症，其治疗或两者兼而有之。对于三分之一的活跃癌症治疗后，疼痛将持续下来。 有1,550万美国人患有癌症，这是一个实质性的公共卫生问题。而很多 存在完全和替代药物的方法，它们在癌症疼痛中的临床用途仍然认真 由于缺乏强大的证据，短期缓解和自付费用过高而受到阻碍。反过来，阿片类药物疼痛 药物是针对癌症患者开的 - 特别是，他们也被排除在大多数州和政策之外 阿片类药物的倡议。长期（> 3 月份 ）阿片类药物疗法在癌症门诊患者中也普遍存在 与年龄性匹配的对照相比。尽管如此，癌症患者几乎总是 排除 从 t 他最近的健康状况 管理” 研究研究了长期阿片类药物疗法和使用的结果。 和人类 服务疼痛管理机构间工作组已确定“自我 作为改善慢性疼痛的最佳实践之一。但是，干预措施不能是 由于我们目前对癌症门诊患者的疼痛自我管理和 特别是他们的阿片类药物自我管理。最近的系统评价表明大多数癌症疼痛 干预措施（基于知识翻译，主要或仅与白人患者进行） 改善知识，但在很大程度上不会改善对患者（例如每日疼痛，功能或 生活质量。这强调了继续寻找干预开发的其他目标。这 6个月的前瞻性队列研究将产生有关纵向疼痛，阿片类药物自我的新知识 在日常疼痛的背景下，管理轨迹以及癌症门诊患者的相关结果 耀斑，关键的临床主持人和协变量。共有400名癌症门诊患者（50％的非裔美国人； 50％ 处方长效（LA）阿片类药物的妇女将从三个城市肿瘤学中心招募。 纵向阿片类药物的自我管理模式将使用用药事件监控实时捕获 系统（MEMS®）。每天的背景疼痛，疼痛和使用“需要”阿片类药物的使用 自我报告跟踪器（SRT®）。患者报告的结果（PRO）是疼痛水平的变化， 功能，睡眠和与健康相关的生活质量。卫生服务成果包括计划外住院 和急诊科的使用（医疗保健利用）。这项研究将提供严格的数据，全面 一组社会人口统计学和临床​​协变量，以及关键的主持人，在此过程中进一步研究止痛 管理最佳实践可以基于，包括改善赛车分布的目标。总体而言，这 研究可以对癌症疼痛管理科学产生持续的影响。