长期肺癌生存期中的持续性阿片类药物使用：何时开始？

Introduction: Lung cancer survivors had a high rate of long-term opioid use. Prolonged opioid use was associated with reduced survival and increased recurrence. It is unknown to what extent opioids initiated during cancer treatment accounted for long-term use. This study aims to characterize the patterns of opioid use in the first year of lung cancer long-term survivorship (LTS) and the history of opioid prescriptions (Rxs) by such patterns. Method: We used the 2010-19 SEER-Medicare linked data to identify a sample of lung cancer survivors enrolled in traditional Medicare Parts A&B and Part D for ≥84 months - 12 months before and 72 months after (including) the month of lung cancer diagnosis, who had ≥1 opioid Rx during the first year of LTS (months 61-72 post diagnosis). We constructed a sequence of daily opioid possession status (0/1) for each patient over the first year of LTS. We applied agglomerative hierarchical clustering to identify groups with distinct patterns. For each patient over the 84 months, we identified the earliest opioid Rx observed, earliest opioid episode that was ≥30 days, and earliest episode that was ≥90 days, if any. Episodes were defined based on filling date and days of supply of consecutive opioid Rxs; a gap of ≥30 days ends the episode. Results: 1,176 survivors were identified with ≥1 opioid Rxs in the first year of LTS. Clustering identified three groups: “persistent use” (N=301, 26%), “intermittent use” (N=176, 15%), and “sporadic use” (N=699, 60%), with median days of opioid possession of 343, 168, and 10, respectively. More than 90% of the persistent-use group had their first opioid Rx before lung cancer diagnosis. There was a sharp gradient across the 3 groups in percentage with first 30- or 90- day episode before cancer diagnosis (Table). Conclusions: An overwhelming proportion of survivors with persistent or intermittent opioid Rxs during first year of LTS started opioid therapies and, to a less extent, long-term opioid therapies, prior to lung cancer diagnosis. Earliest opioid prescription and long-term episodes observed across three groups of survivors Persistent Use (N = 301) Intermittent Use (N = 176) Sporadic Use (N = 699) Earliest Opioid Prescription Observed 12 months before diagnosis 276 (92%) 144 (82%) 463 (66%) Months 1 - 12 after diagnosis 20 (6.5%) 28 (16%) 188 (27%) Months 13-60 after diagnosis 5 (1.7%) 4 (2.3%) 32 (4.6%) Months 61-72 after diagnosis 0 (0%) 0 (0%) 16 (2.3%) Never N/A N/A N/A Earliest 30-Day Opioid Episode Observed 12 months before diagnosis 250 (83%) 114 (65%) 220 (31%) Months 1 - 12 after diagnosis 36 (12%) 37 (21%) 163 (23%) Months 13-60 after diagnosis 14 (4.7%) 19 (11%) 85 (12%) Months 61-72 after diagnosis 1 (0.33%) 6 (3.4%) 58 (8.3%) Never 0 (0%) 0 (0%) 173 (25%) Earliest 90-Day Opioid Episode Observed 12 months before diagnosis 226 (75%) 79 (45%) 104 (15%) Months 1 - 12 after diagnosis 34 (11%) 28 (16%) 49 (7.0%) Months 13-60 after diagnosis 38 (13%) 43 (24%) 58 (8.3%) Months 61-72 after diagnosis 3 (1.0%) 15 (8.5%) 33 (4.8%) Never 0 (0%) 11 (6.3%) 455 (65%)