癌症病人生命末期鴉片類藥物利用

Abstract

研究目的 此研究欲分析臺灣癌症病人生命末期之鴉片類藥物利用，包含是否開立鴉片類藥物、鴉片類藥物累積劑量，並分析族群特性與鴉片類藥物利用之相關性。 病人及研究方法 這是一篇橫斷性研究，使用臺灣健保資料庫2005年承保抽樣歸人檔中的四萬人，篩選出2005-2007年死亡之癌症病人，共152位癌症病人納入分析。分析全體癌症病人死亡前三個月之鴉片類藥物利用。針對腸胃道癌症病人，使用多元邏輯斯迴歸、多層次邏輯斯迴歸及廣義線性模型分析其鴉片類藥物利用之相關因子。 研究結果 本篇研究癌症病人於死亡前三個月鴉片類藥物開立率為78.4%，其鴉片類藥物累積劑量之中位數為670 mg OMEQ(oral morphine equivalent)(標準差, 3928)。在藥物種類分析中，morphine是最主要的鴉片類用藥(開立率: 69.2%、總累積劑量:156,000 mg OMEQ)；而在弱效鴉片類用藥中，則以tramadol為主要用藥(開立率: 46.7%、總累積劑量:62,805 mg)。而腸胃道癌症病人鴉片類藥物利用分析中，經校正後，鴉片類藥物開立率以2007年最高(OR=8.28, 95%CI=1.03-66.37)；共病症分數為2分者，鴉片類藥物累積劑量預估值較高(2,357, P=0.037)。 結論 臺灣的癌症病人多數於生命末期曾被處方鴉片類藥物。在鴉片類藥物中，主要用藥為morphine；而弱效鴉片類主要用藥為tramadol。鴉片類藥物利用較高之相關因子包含死亡年份為2007年及共病症分數為2分者。

Purpose This study aimed to analyze opioid utilization of Taiwan cancer patients at the end of life. Opioid prescripation rate, accumulated opioid dose and factors associated with opioid utilization were determined. Patients and Methods We conducted a cross-sectional study based on Longitudinal Health Insurance Database 2005 from National Health Insurance Research Database in Taiwan. All cancer patients who died during 2005-2007 were identified (N=152) and opioid utilization during the last three months of life were analyzed. Among patients with gastrointestinal cancer (N=78), factors associated with opioid utilization were analyzed by logistic regression, multilevel logistic regression, and generalized linear model. Results The opioid prescription rate was 78.4%.The median accumulated opioid dose was 670 mg oral morphine equivalent(OMEQ)(Standard Deviation: 3,928). Morphine was the mainly prescribed opioid (prescription rate: 69.2%, OMEQ: 156,000 mg), while tramadol was the mainly prescribed weak opioid (prescription rate: 46.7%, OMEQ: 62,805 mg).For patients with gastrointestinal cancer, opioid prescription rate was higher if patients died in 2007(OR:8.28, 95%CI=1.03-66.37) and the estimated opioid dosage was higher for patients with Charlson comorbidity index=2(estimate:2,357, P=0.037) after adjustment. Conclusion Most cancer patients in Taiwan were prescribed with opioids at the end of life. The mostly prescribed opioids was morphine, and the mostly prescribed weak opioids was tramadol. Factors associated with higher opioid utilization were patients died in 2007 and with Charlson comorbidity index=2.