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 长期与癌症相关的疼痛非常普遍，国际指南长期以来支持使用 阿片类药物治疗与活动疾病有关的中度至剧烈疼痛。这种共识的优势是 对于患有晚期疾病和预期寿命有限的患者来说，强大。适用于经历的患者 长期缓解，或稳定或懒惰的疾病，无需持续的抗癌治疗（“长期 术语生存制度”），有新兴的共识，应在类似的情况下解决OID疗法 与慢性非癌症患者一样。关于最佳实践的歧义 接受用于治疗的主动抗癌治疗的患者。阿片类流行病之后 政策已经激增，以减少不安全的阿片类药物处方。最近的主要政策包括 处方者参与处方药监测计划（PDMP）和州的州授权 急性疼痛的持续时间和/或剂量的立法限制。这些政策在他们的 预期适用于癌症患者的亚群，并与临床的歧义相结合 最佳实践可能无意中影响了阿片类药物的使用和相关结果 癌症患者的亚群。我们提出了一项研究，以评估预期和意外的后果 阿片类药物处方的两种状态政策以及与疼痛和阿片类药物有关的不良健康事件 在患有晚期疾病的癌症患者中，长期存活和患有活性癌症的患者 治疗。为了帮助阐明响应政策变化的机制，我们还将探索 使用创新模式，在每个亚群中分发阿片类药物的轨迹和临床相遇 采矿方法。我们将使用Seer-Medicare链接数据库和大型国家商业保险 实现研究目的的数据库。调查结果将为建立共识，指南和干预提供信息 提供者，医疗保健组织和政策制定者的发展，政策和实践的变化 优化癌症患者的OOID处方和疼痛管理。