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Abstract：
BACKGROUND: Cancer-related pain is one of the common priority symptoms in advanced lung cancer patients at the end-of-life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription-level outcomes as potential indicators of undertreated pain in China.
METHODS: This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription-level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively.
RESULTS: A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%-45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31-60 days to the 0-30 days of life, the MMED declined 6.08 mg (95% CI: -7.14 to -5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160-1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: -5.86 to -2.37; p = 0.005) within the last month before death compared to the previous month.
CONCLUSIONS: Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.
METHODS: This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription-level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively.
RESULTS: A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%-45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31-60 days to the 0-30 days of life, the MMED declined 6.08 mg (95% CI: -7.14 to -5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160-1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: -5.86 to -2.37; p = 0.005) within the last month before death compared to the previous month.
CONCLUSIONS: Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.
摘要：
背景：癌症相关疼痛是晚期肺癌患者临终期（EOL）的常见优先症状之一。缓解疼痛无疑是肺癌姑息治疗的重要组成部分。我们的研究旨在研究阿片类药物处方水平结局的趋势，作为中国治疗不足疼痛的潜在指标。
方法：本研究采用2014-2017年中国城市医疗保险诊断肺癌患者1330例资料。阿片类药物处方水平的结果由服用阿片类药物处方的患者比例的年度趋势决定。死者填充的阿片类药物的总剂量，和吗啡毫克当量每天(MMED)在EOL(定义为死亡前60天)。我们进一步分析了阿片类药物处方数量的每月变化，MMED,和平均每日剂量的阿片类药物的处方（MDDP）的最后60天的生命的一年和年龄，分别。
结果：共纳入959例患者的确切死亡日期，432例（45.06%；95%CI：44.36%-45.77%）在EOL接受至少一种阿片类药物处方。服用阿片类药物的患者比例呈下降趋势，死者和MMED填充的阿片类药物的总剂量，年下降0.341%(p=0.01)，104.23毫克（p=0.011）和2.84毫克（p=0.014），分别。在31-60天到0-30天的生命中，MMED下降6.08毫克（95%CI：-7.14至-5.03；p=0.000351），阿片类药物处方数量上升0.66（95%CI：0.160-1.16；p=0.025）。像MMED一样,与前一个月相比，MDDP在死亡前最后一个月下降了4.11mg（95％CI：-5.86至-2.37；p=0.005）。
结论：中国城市晚期肺癌人群在EOL获得阿片类药物的机会减少。临床医生没有给每个处方开出令人满意的阿片类药物剂量，而患者在生命的最后30天内疼痛加剧。在EOL期间，肺癌患者应提倡使用足够的阿片类镇痛药。
方法：本研究采用2014-2017年中国城市医疗保险诊断肺癌患者1330例资料。阿片类药物处方水平的结果由服用阿片类药物处方的患者比例的年度趋势决定。死者填充的阿片类药物的总剂量，和吗啡毫克当量每天(MMED)在EOL(定义为死亡前60天)。我们进一步分析了阿片类药物处方数量的每月变化，MMED,和平均每日剂量的阿片类药物的处方（MDDP）的最后60天的生命的一年和年龄，分别。
结果：共纳入959例患者的确切死亡日期，432例（45.06%；95%CI：44.36%-45.77%）在EOL接受至少一种阿片类药物处方。服用阿片类药物的患者比例呈下降趋势，死者和MMED填充的阿片类药物的总剂量，年下降0.341%(p=0.01)，104.23毫克（p=0.011）和2.84毫克（p=0.014），分别。在31-60天到0-30天的生命中，MMED下降6.08毫克（95%CI：-7.14至-5.03；p=0.000351），阿片类药物处方数量上升0.66（95%CI：0.160-1.16；p=0.025）。像MMED一样,与前一个月相比，MDDP在死亡前最后一个月下降了4.11mg（95％CI：-5.86至-2.37；p=0.005）。
结论：中国城市晚期肺癌人群在EOL获得阿片类药物的机会减少。临床医生没有给每个处方开出令人满意的阿片类药物剂量，而患者在生命的最后30天内疼痛加剧。在EOL期间，肺癌患者应提倡使用足够的阿片类镇痛药。
