The effects of hydrocodone rescheduling on pain management of older lung cancer patients

氢可酮重新安排对老年肺癌患者疼痛管理的影响

• 批准号: 10599385
• 负责人: Chan Shen
• 金额: $ 47.1万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10599385
• 关键词: Acute; Address; Affect; Analgesics; Anticonvulsants; Antidepressive Agents; Cancer Pain Management; Cancer Patient; Communities; Complex; Data; Distress; Face; Future; Goals; Hydrocodone; Lead; Link; Literature; Malignant Neoplasms; Malignant neoplasm of lung; Medical; Medicare; Medicare claim; Medicare/Medicaid; Metastatic Neoplasm to the Bone; Morphine; Muscle relaxants; Non-Steroidal Anti-Inflammatory Agents; Opioid; Outcome; Pain; Pain management; Patients; Pharmaceutical Preparations; Pharmacotherapy; Policies; Population; Postoperative Pain; Prevalence; Provider; Public Health; Quality of life; Research; Schedule; Services; Symptoms; Underserved Population; United States; United States Centers for Medicare and Medicaid Services; cancer care; cancer health disparity; cancer therapy; cancer type; clinical practice; data registry; disabling symptom; disparity reduction; dual eligible; ethnic minority population; experience; health related quality of life; improved; insight; milligram; multidisciplinary; neoplasm registry; non-opioid analgesic; opioid epidemic; opioid misuse; opioid use; painful neuropathy; prescription opioid; prescription opioid misuse; prevent; racial and ethnic; response; surgical pain

Project Summary Pain is a highly prevalent, complex, debilitating symptom for cancer patients. Pain management is an essential component of cancer care. Adequate pain management can significantly improve health-related quality of life for patients. However, there are substantial disparities in access to adequate pain management especially among underserved and underprivileged populations. Meanwhile, the opioid epidemic is a serious public health crisis, and there have been many policy efforts to curb opioid misuse. One important policy change is the rescheduling of hydrocodone from Schedule III to Schedule II in 2014 by the United States Drug Enforcement Administration. However, prior literature has shown mixed evidence on the actual overall impacts of this policy, as patients could either receive non-opioid pharmacotherapy (e.g. nonsteroidal anti-inflammatory drugs, antidepressants, muscle relaxant, anticonvulsants) or stronger opioids as replacements for hydrocodone. Additionally, few studies examined the impact on pain management strategies and outcomes among cancer patients, who may face potentially higher barriers to adequate pain management. Further, how the policy change affects underserved and underprivileged groups is largely unknown. We propose to use national cancer registry data linked with Medicare claims (SEER- Medicare) to comprehensively examine the effects of the rescheduling of hydrocodone on older lung cancer patients with a special focus on underserved and underprivileged groups. The proposed study is well in line with the R21 RFA calling for research that utilizes Centers for Medicare and Medicaid Services (CMS) administrative data to study pain management strategies and outcomes, including underserved and underprivileged groups. We will address the following aims: Aim 1. Examine the change in opioid and non- opioid pharmacotherapy use among older lung cancer patients before and after the rescheduling of hydrocodone from Schedule III to Schedule II. Aim 2. Compare the adequacy of pain management in terms of prevalence of service use consistent with inadequate pain management among older lung cancer patients before and after the rescheduling. Aim 3. Examine potential disparities in the use of medications for pain management and service use consistent with inadequate pain management among older lung cancer patients dually eligible for both Medicare and Medicaid and among patients in racial/ethnic minority groups. The proposed study will provide important insights to guide policy efforts and clinical practice aimed at improving pain management and reducing disparities in cancer patients.

项目摘要 疼痛是癌症患者的高度普遍，复杂，令人衰弱的症状。疼痛 管理是癌症护理的重要组成部分。足够的疼痛管理可以 显着改善患者健康相关的生活质量。但是，有很大的 获得足够疼痛管理的差异，尤其是在服务不足和 贫困人口。同时，阿片类药物流行是严重的公共卫生危机， 而且已经做出了许多政策努力来遏制阿片类药物滥用。一个重要的政策改变是 美国2014年美国附表III至2014年附表II的氢可酮重新安排 毒品执法局。但是，先前的文献显示了关于 该政策的实际总体影响，因为患者可以接受非阿片类药物 药物治疗（例如非甾体类抗炎药，抗抑郁药，肌肉松弛剂， 抗惊厥药）或更强的阿片类药物作为氢可酮的替代。另外，很少 研究检查了对癌症疼痛管理策略和结果的影响 患者可能面临可能更高的疼痛管理障碍。此外，如何 政策变化影响了服务不足和贫困群体是未知的。 我们建议使用与Medicare主张相关的国家癌症注册表数据（Seer- Medicare）全面检查氢可酮对较老的重新安排的影响 肺癌患者特别关注服务不足和弱势群体。这 拟议的研究与R21 RFA呼吁进行研究非常一致，该研究利用了中心 医疗保险和医疗补助服务（CMS）管理数据以研究疼痛管理 策略和结果，包括服务不足和弱势群体。 我们将解决以下目的：目标1。检查阿片类药物和非 - 在老年肺癌患者中使用阿片类药物治疗前后 将氢可酮从附表III重新安排到附表II。目标2。比较足够的 在服务使用率方面的疼痛管理与不足的疼痛一致 重新安排前后老年肺癌患者的管理。目标3。 检查使用用于疼痛管理和服务使用的药物的潜在差异 与老年肺癌患者的疼痛管理不足一致 对于Medicare和Medicaid以及种族/族裔少数民族群体中的患者。 拟议的研究将提供重要的见解，以指导政策努力和临床 旨在改善疼痛管理并减少癌症患者差异的实践。