Junyong Lee MD, PhD , Chung-woo Lee MD , Hwa Sun Kim MD , Hak Ryeong Kim MD , Soo Yun Lim RN , Jung Ran Kim RN
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引用次数: 0
Abstract
Context
Polypharmacy and inappropriate prescribing are prevalent among end-of-life cancer patients, potentially compromising symptom management and quality of life. Limited data are available on potentially inappropriate medications (PIMs) and prescribing omissions (PPOs) of opioid in South Korea, particularly in home-based hospice care settings.
Objectives
This study aimed to evaluate the prevalence of PIMs and PPOs in advanced cancer patients referred to home-based hospice care and identify factors associated with these prescribing issues.
Methods
A retrospective observational study included 102 advanced cancer patients referred to a single center's home-based hospice care between November 2022 and November 2023. PIMs were assessed using the STOPPFrail criteria, while PPOs were defined as inadequate opioid prescribing omissions for moderate to severe cancer pain. Logistic regression analysis identified factors associated with PIMs and PPOs.
Results
PIMs were observed in 40.2% of patients, with higher prevalence in those over 70 years old (48.7%) and those with multiple comorbidities. Statins (25.5%) and antihypertensives (29.4%) were the most common PIMs. Among patients with moderate to severe cancer pain, 45.5% experienced PPOs due to inadequate opioid prescriptions. Older age (OR 3.90, P < 0.01) and comorbidities (OR 20.90, p < 0.01) were significantly associated with PIMs, while diabetes was linked to PPOs (OR 2.00, P = 0.01).
Conclusion
The findings highlight critical gaps in medication management for end-of-life cancer patients. Systematic deprescribing protocols and improved strategies to address opioid stigma and prescribing hesitancy are essential to align treatments with end-of-life care goals and enhance patient quality of life.
背景：多种用药和不当处方在晚期癌症患者中普遍存在，潜在地影响症状管理和生活质量。关于韩国阿片类药物的潜在不适当药物（PIMs）和处方遗漏（PPOs）的数据有限，特别是在家庭临终关怀环境中。目的：本研究旨在评估接受居家安宁疗护的晚期癌症患者中不良行为及不良行为的发生率，并找出与这些处方问题相关的因素。方法：一项回顾性观察性研究纳入了2022年11月至2023年11月期间在单一中心进行家庭临终关怀的102例晚期癌症患者。使用stopp虚弱标准评估PIMs，而PPOs被定义为中度至重度癌症疼痛的阿片类药物处方遗漏不足。Logistic回归分析确定了与PIMs和PPOs相关的因素。结果：40.2%的患者出现PIMs，其中70岁以上患者（48.7%）及合并多种合并症的患者患病率较高。他汀类药物（25.5%）和抗高血压药物（29.4%）是最常见的pim。在中度至重度癌性疼痛患者中，45.5%的患者因阿片类药物处方不足而出现PPOs。年龄（OR 3.90, p < 0.01）和合并症（OR 20.90, p < 0.01）与PIMs显著相关，而糖尿病与PPOs相关（OR 2.00, p = 0.01）。结论：研究结果突出了临终癌症患者药物管理的关键差距。系统的处方解除方案和改进的策略，以解决阿片类药物耻辱和处方犹豫，对于使治疗与临终关怀目标保持一致并提高患者的生活质量至关重要。
期刊介绍：
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
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