Journal of Pharmaceutical Health Care and Sciences最新文献

Background: Pain is one of the most distressing symptoms in patients with cancer. Although established guidelines now recommend appropriate opioid use, even for mild-to-moderate pain, Japan's prescription volume remains markedly lower than that of Western countries. Public ambivalence, recognizing opioids as effective yet fearing dependence and adverse effects, may contribute to this underuse. However, little is known about how indirect exposure to opioids through family members' cancer treatments shapes such attitudes. This study examined the perceived barriers to and willingness to use medical opioids among cancer-free adults, focusing on the influence of family experiences with opioid use.

Methods: A cross-sectional web-based survey was conducted on July 30, 2025, among 618 Japanese adults aged 20-49 years without a history of cancer. Participants were categorized into three groups: Opioid+ (family with cancer and opioid use), Opioid- (family with cancer but no opioid use), and None (no family history of cancer). Psychological barriers were assessed using the Japanese version of the Barriers Questionnaire II (JBQ-II), comprising an overall score and five subscales. Willingness to use opioids in a hypothetical mild-to-moderate cancer pain scenario was rated on a 10-point Likert scale. Group differences were analyzed using Kruskal-Wallis and Steel-Dwass tests (two-tailed p < 0.05).

Results: Compared with the None group, the Opioid + group showed significantly higher scores for overall JBQ-II (3.23 vs. 3.11, p < 0.01), Physiological Effects (3.47 vs. 3.32, p < 0.05), Harmful Effects (3.32 vs. 3.12, p < 0.001), and Disease Progression (3.65 vs. 3.39, p < 0.01), but lower Fatalism scores (2.25 vs. 2.46, p < 0.05). Willingness to use medical opioids was also higher in the Opioid + group (7.43) than in the Opioid- (6.55, p < 0.01) and None groups (6.59, p < 0.01).

Conclusions: Indirect exposure to opioids through family members' cancer treatment was associated with ambivalent attitudes, characterized by greater recognition of barriers alongside increased willingness to use medical opioids. Addressing this experience-based ambivalence through evidence-based education, individualized counseling using the JBQ-II, and family-involved communication support may help promote the safe and appropriate use of medical opioids in Japan's cultural and public health contexts.

Clinical trial number: Not applicable.

Background: Atovaquone (Atov), a second-line drug, is used to treat patients with Pneumocystis pneumonia (PCP) who cannot tolerate sulfamethoxazole/trimethoprim (SMX/TMP). However, the efficacy and safety of Atov are based on clinical trials conducted in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome, with limited data available on HIV-uninfected individuals with PCP (non-HIV PCP). In this study, we retrospectively evaluated the clinical outcomes of switching from SMX/TMP to Atov in patients with non-HIV PCP.

Methods: The study included patients with non-HIV PCP who were admitted to Fukuoka University Hospital between 2016 and 2023 and initially received SMX/TMP therapy. The primary endpoint was 30-day survival rate from the date of PCP diagnosis. Secondary endpoints included factors associated with mortality and the cumulative incidence of switching from SMX/TMP to Atov.

Results: Of the 56 patients receiving SMX/TMP therapy for PCP, 17 were switched to Atov due to SMX/TMP-related side effects. The Kaplan-Meier estimated 30-day survival was 76.9% in the "remained on" SMX/TMP group and 82.4% in the "switched to" Atov group (log-rank test, P = 0.58). Univariable logistic regression analysis of 30-day mortality showed that switching to Atov was not associated with higher mortality compared with continued SMX/TMP therapy (odds ratio 0.71, 95% confidence interval 0.17 to 3.05). The Kaplan-Meier estimated cumulative incidence of switching from SMX/TMP to Atov during the PCP treatment period was 33.8%.

Conclusion: Our data suggest that switching from SMX/TMP to Atov may not be associated with worse survival. Long-term administration of SMX/TMP is often challenging due to its side effects, and in this study, more than 30% of patients were unable to tolerate its therapeutic dose. Our findings support the role of Atov as a viable second-line treatment for PCP in immunocompromised patients, such as those with non-HIV PCP.