在丸癌患者中使用阿片类药物:模式和危险因素
Siddharth Marthi1, Gregory Palmateer1, Dattatraya Patil1
1Department of Urology, Emory University School of Medicine, Atlanta, GA.
Clinical genitourinary cancer
|June 20, 2025
概括
经管切除术后接受阿片类药物处方的丸癌患者面临持续使用阿片类药物的更高风险. 化学疗法等先进的治疗方法,但不仅仅是逆关节淋巴结解剖,显著增加了这种风险.
科学领域:
- 在瘤学瘤学.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 疼痛管理 疼痛管理
背景情况:
- 处方阿片类药物的使用可以导致慢性依赖,发病率和死亡率.
- 接受泌尿外科手术的男性患阿片类药物持续使用的风险增加.
- 驱使丸癌患者持续使用阿片类药物的因素尚不清楚.
研究的目的:
- 鉴定丸癌患者在切除术后持续使用阿片类药物相关的因素.
- 调查先进治疗对长期阿片类药物需求的影响.
主要方法:
- 利用Truven Marketscan数据库 (2009-2021) 对经历切除术的丸癌患者进行分析.
- 排除了先前使用或患有阿片类药物障碍的患者,以及未满18岁或没有保险的患者.
- 基于处方的定义阿片类药物暴露在治疗后30天内完成,包括先进治疗患者的治疗前使用.
- 采用多变量逻辑回归来分析阿片类药物处方风险因素治疗后31-180天.
主要成果:
- 治疗后30天内的阿片类药物暴露与随后的阿片类药物处方 (31-90和91-180天治疗后) 有显著的相关性.
- 先进的治疗,特别是化疗 (单独或与RPLND),独立地与治疗后31-180天的阿片类药物使用增加有关.
- 单独的逆皮质淋巴结解剖 (RPLND) 没有显示与持续的阿片类药物使用有显著的关联.
结论:
- 丸癌症患者接受最初的阿片类药物处方后的骨架切除术有更高的风险继续使用.
- 化疗,有或没有RPLND,是该队列中长期阿片类药物依赖的重要危险因素.
- 单独使用RPLND似乎不会增加在切除术后持续使用阿片类药物的风险.
相关概念视频
01:20Disorders of the Male Reproductive System
611
Men's health issues are increasingly recognized as significant, with several conditions posing common threats. Among these, testicular cancer is especially prevalent in younger men, particularly those aged 20 to 35 years. The disease often manifests as a painless mass in the testicles, sometimes accompanied by a sensation of heaviness or a dull ache.
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
611
01:21Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
371
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
371
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
382
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
382
01:25Analgesia and Pain Management
822
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
822
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
453
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
453