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

项目摘要 疼痛是癌症患者的一种高度普遍、复杂、使人衰弱的症状。疼痛 管理是癌症护理的重要组成部分。适当的疼痛管理可以 显著改善患者健康相关生活质量。然而，有大量的 获得适当疼痛管理的机会不均等，特别是在服务不足和 贫困人口。与此同时，阿片类药物的流行是一个严重的公共卫生危机， 而且已经有许多政策努力来遏制阿片类药物滥用。一个重要的政策变化是 美国于2014年将氢可酮从附表三改为附表二 缉毒署。然而，先前的文献显示了关于 这一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品。此外，少数 研究检查了癌症患者疼痛管理策略和结果的影响， 患者，他们可能面临更高的障碍，以充分的疼痛管理。此外，如何 政策变化对服务不足和弱势群体的影响在很大程度上是未知的。 我们建议使用与医疗保险索赔相关的国家癌症登记数据（SEER- 医疗保险），以全面检查氢可酮的重新安排对老年人的影响， 肺癌患者，特别关注服务不足和弱势群体。的 拟议的研究完全符合R21 RFA要求的研究， 研究疼痛管理的医疗保险和医疗补助服务（CMS）管理数据 战略和成果，包括得不到充分服务和处境不利的群体。 我们将致力于实现以下目标：目标1。检查阿片类药物和非阿片类药物的变化 阿片类药物治疗在老年肺癌患者中的应用 将氢可酮从附表III重新安排到附表II。目标2.比较以下各项的适当性： 根据与疼痛不充分一致的服务使用率进行疼痛管理 老年肺癌患者在重新安排治疗前后的管理。目标3： 检查疼痛管理和服务使用药物的潜在差异 与双重合格的老年肺癌患者中的疼痛管理不足一致 对于医疗保险和医疗补助以及种族/少数民族群体的患者。 拟议的研究将提供重要的见解，以指导政策努力和临床 旨在改善疼痛管理和减少癌症患者差异的实践。

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.