Understanding and Addressing Opioid and Benzodiazepine Co-prescribing among Older Adults with Cancer

项目总结/摘要 在癌症诊断后，阿片类药物和苯二氮卓类药物处方重叠的可能性很大， 高达30%的患者同时使用这两种药物。阿片类药物仍然是 癌症相关的疼痛管理，苯二氮卓类药物经常被用来帮助患者管理 癌症的其他常见症状及其治疗。当联合处方时，阿片类药物和 苯二氮卓类药物可能会产生危及患者安全和健康的非预期后果- 特别是对于老年患者。在一般人群的老年人中， 苯二氮卓类药物与伤害性福尔斯、骨折和阿片类药物的风险显著增加有关。 药物过量事件。阿片类药物和苯二氮卓类药物联合处方的风险可能会在老年人中加剧 癌症患者更容易受到阿片类药物和苯二氮卓类药物对姿势稳定性的影响， 化疗对神经系统的影响。此外，患有癌症的老年人经常 经历呼吸困难（即，呼吸困难），这可能进一步使他们倾向于阿片类药物-和 苯二氮卓类药物相关的呼吸抑制--过量死亡的原因。目前，有关键的 知识差距阻碍了老年人的努力，以（1）减少可避免的共同处方 阿片类药物和苯二氮卓类药物，以及（2）预防暴露于 在癌症诊断后使用这种药物组合。首先，我们缺乏关于人口水平的基本知识 阿片类药物和苯二氮卓类药物在老年癌症患者中的共同处方模式。第二，没有任何研究 检查了这一人群中共同开药造成的伤害负担。第三，不 研究探讨了提供者对阿片类药物和苯二氮卓类药物联合处方的看法， 老年癌症患者我们提出的研究使用解释性序贯混合方法设计， 弥补这些证据缺口。我们研究的定量阶段将使用SEER-Medicare数据（a） 描述诊断为乳腺癌的老年人中阿片类药物和苯二氮卓类药物联合处方的模式， 结直肠癌或肺癌（目标1）和（B）检查与阿片类药物相关的可避免伤害的风险， 苯二氮卓类药物在该人群中联合处方（目标2）。在定性阶段， 研究，我们将进行半结构化访谈， 提供者确定影响其实践的因素 关于老年癌症患者的联合处方和降低相关风险（目标3）。在 本研究的结论，我们将有一个上下文丰富的了解程度的共同处方， 老年癌症患者联合处方可能造成的危害，以及可能促进 或阻碍减少不必要的联合处方和改善风险缓解策略的使用， 共同开药被认为是临床有益的。

PROJECT SUMMARY/ABSTRACT After a cancer diagnosis, the potential for overlap in opioid and benzodiazepine prescriptions is substantial, with up to 30% of patients concurrently prescribed both types of drugs. Opioids continue to be the mainstay of cancer-related pain management, and benzodiazepines are frequently prescribed to help patients manage other common symptoms of cancer and its treatment. When prescribed in combination, opioids and benzodiazepines can have the unintended consequence of compromising patient safety and well-being— particularly for older patients. Among older members of the general population, co-prescribing of opioids with benzodiazepines has been linked to a substantially increased risk of injurious falls, fractures, and opioid overdose events. The risks of opioid and benzodiazepine co-prescribing may be compounded in older adults with cancer, who are more vulnerable to the effects of opioids and benzodiazepines on postural stability and cognition due to the neurological effects of chemotherapy. In addition, older adults with cancer frequently experience breathing difficulties (i.e., dyspnea), which can further predispose them to opioid- and benzodiazepine-related respiratory depression—the cause of overdose death. At present, there are critical knowledge gaps that hinder efforts in the older adult population to (1) reduce avoidable co-prescribing of opioids and benzodiazepines after a cancer diagnosis and (2) prevent harms among those who are exposed to this drug combination after a cancer diagnosis. First, we lack fundamental knowledge about population-level patterns of opioid and benzodiazepine co-prescribing among older adults with cancer. Second, no studies have examined the burden of harms resulting from co-prescribing among members of this population. Third, no studies have explored providers’ perspectives with respect to opioid and benzodiazepine co-prescribing among older patients with cancer. Our proposed study uses an explanatory sequential mixed-methods design to address these evidence gaps. The quantitative phase of our study will use SEER-Medicare data to (a) Characterize patterns of opioid and benzodiazepine co-prescribing among older adults diagnosed with breast, colorectal, or lung cancer (Aim 1) and (b) Examine the risks of avoidable harms associated with opioid and benzodiazepine co-prescribing among members of this population (Aim 2). In the qualitative phase of the study, we will conduct semi-structured interviews with providers to identify factors that influence their practices with respect to co-prescribing and mitigating associated risks among older adults with cancer (Aim 3). At the conclusion of this study, we will have a contextually rich understanding of the extent of co-prescribing and harms potentially resulting from co-prescribing among older adults with cancer, and factors that may facilitate or hinder efforts to reduce unnecessary co-prescribing and improve the use of risk mitigation strategies when co-prescribing is deemed clinically beneficial.