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

项目摘要/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%的患者同时开了这两种药物。阿片类药物继续是 癌症相关的疼痛管理，和苯二氮卓类药物经常被开来帮助患者管理 癌症的其他常见症状及其治疗。当阿片类药物和阿片类药物联合使用时 苯二氮卓类药物可能会产生意想不到的后果，危及患者的安全和福祉- 尤其是对年龄较大的患者。在一般人口的老年成员中，与阿片类药物联合处方 苯二氮卓类药物与严重跌倒、骨折和阿片类药物的风险显著增加有关。 服药过量事件。在老年人中，阿片类药物和苯二氮卓类药物联合处方的风险可能会增加 患有癌症的人，更容易受到阿片类药物和苯二氮卓类药物对姿势稳定性和 由于化疗的神经影响而产生的认知。此外，经常患有癌症的老年人 经历呼吸困难(即呼吸困难)，这可能进一步使他们易受阿片类药物的影响--和 苯二氮类药物引起的呼吸抑制--过量死亡的原因。目前，有一些关键的 阻碍老年人口努力(1)减少可避免的联合处方的知识差距 阿片类药物和苯二氮类药物在癌症诊断后和(2)预防接触者的伤害 癌症确诊后的这种药物组合。首先，我们缺乏关于人口水平的基本知识 老年癌症患者阿片类药物和苯二氮卓类药物联合处方的模式。其次，没有研究表明 检查了在这一人群中联合开处方所造成的伤害负担。第三，不 研究探索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。我们建议的研究使用解释性顺序混合方法设计 填补这些证据空白。我们研究的定量阶段将使用SEER-Medicare数据来(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)审查与阿片类药物和 苯二氮卓类药物在该人群成员中的联合处方(目标2)。在定性阶段， 研究中，我们将进行半结构化访谈， 提供商以确定影响其实践的因素 关于共同处方和减轻老年癌症患者的相关风险(目标3)。在 这项研究的结论，我们将有一个背景丰富的理解联合处方和 老年癌症患者联合用药可能造成的危害，以及可能促进 或妨碍减少不必要的联合处方和改进风险缓解策略的使用的努力 联合处方被认为是临床上有益的。

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.