Outcomes of a Specialized Interdisciplinary Approach for Patients with Cancer with Aberrant Opioid-Related Behavior
Outcomes of a Specialized Interdisciplinary Approach for Patients with Cancer with Aberrant Opioid-Related Behavior
复制标题
DOI：
10.1634/theoncologist.2017-0248
复制
发表时间：
2018-02-01
期刊：
影响因子：
5.8
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
Arthur, Joseph;Edwards, Tonya;Bruera, Eduardo
背景资料。关于癌症患者异常阿片类药物相关行为(AB)的有效干预措施的发展和结果的数据缺乏。我们的门诊支持护理诊所开发并实施了一种专门的跨学科团队方法来管理AB患者。这项研究的目的是报告这种新型介入治疗的临床结果。材料和方法。回顾2015年1月1日至2016年8月31日期间连续接受干预的30例有AB证据的患者和70例无AB证据的随机对照组患者的病历。在基线时，AB患者的疼痛强度(p=.002)和阿片类药物剂量(p=.001)显著高于AB患者。在研究过程中，每月ABS的中位数从干预前的3次显著下降到干预后的0.4次(p<；.0001)。虽然疼痛强度没有显著变化(p=.984)，但吗啡等效日剂量的中位数从第一次干预访问时的165 mg/d下降到最后一次随访时的112 mg/d(p=.018)。“早于预期时间在诊所请求阿片类药物补充”是干预前频率最高的AB，也是研究期间改善最大的AB。较年轻的年龄(p<；.0001)和较高的Edmonton症状评估系统焦虑评分(p=.005)是AB的独立预测因素。这一干预措施与接受慢性阿片类药物治疗的癌症患者AB和阿片类药物使用频率的减少有关。需要更多的研究来进一步表征这种干预的临床有效性。
Background. Data on the development and outcomes of effective interventions to address aberrant opioid-related behavior (AB) in patients with cancer are lacking. Our outpatient supportive care clinic developed and implemented a specialized interdisciplinary team approach to manage patients with AB. The purpose of this study was to report clinical outcomes of this novel intervention.Materials and Methods. The medical records of 30 consecutive patients with evidence of AB who received the intervention and a random control group of 70 patients without evidence of AB between January 1, 2015, and August 31, 2016, were reviewed.Results. At baseline, pain intensity (p = .002) and opioid dose (p = .001) were significantly higher among patients with AB. During the course of the study, the median number of ABs per month significantly decreased from three preintervention to 0.4 postintervention (p < .0001). The median morphine equivalent daily dose decreased from 165 mg/day at the first intervention visit to 112 mg/day at the last follow-up (p = .018), although pain intensity did not significantly change (p = .984). "Request for opioid medication refills in the clinic earlier than the expected time" was the AB with the highest frequency prior to the intervention and the greatest improvement during the study period. Younger age (p < .0001) and higher Edmonton Symptom Assessment System anxiety score (p = .005) were independent predictors of the presence of AB.Conclusion. The intervention was associated with a reduction in the frequency of AB and opioid utilization among patients with cancer receiving chronic opioid therapy. More research is needed to further characterize the clinical effectiveness of this intervention.