암 환자에서 초기 마약성 진통제 사용의 적절성 평가 및 응급실 방문과의 상관성 조사 = Appropriateness of Initial Opioid Analgesic Use and Its Association with Emergency Department Visits in Cancer Patients

다국어 초록 (Multilingual Abstract)

Background : Opioid analgesics are mainly recommended for managing moderate to severe cancer-related pain; however, adherence to guideline-based prescribing is crucial due to the risk of adverse effects. This study assessed the appropriateness of initial opioid prescriptions for hospitalized cancer patients and explored their relationship with emergency department (ED) visits within 30 days of discharge.
Methods : This retrospective study included adult cancer patients (≥ 19 years) admitted to Seoul National University Bundang Hospital in 2023 who were newly prescribed extended-release opioids. Appropriateness was evaluated based on six criteria derived from national and international guidelines; prescriptions not meeting one or more criteria were classified as inappropriate. We analyzed ED visits within 30 days post-discharge, focusing on opioid-related and potentially preventable visits. Logistic regression was used to investigate the relationship between prescription appropriateness and ED visits.
Results : Of the 323 patients studied, 68.7% received inappropriate initial extended-release opioid prescriptions. Common issues included the absence of short-acting opioids for breakthrough pain (32.5%) and lack of prophylactic laxatives at discharge (24.1%). A total of 71 patients (22.0%) made 95 ED visits, with pain being the primary reason (26.3%). Among these visits, 35 (36.8%) were opioid-related, and 11 (31.4%) were considered preventable. No significant association was found between inappropriate prescribing and ED visits (odds ratio 1.42; 95% confidence interval, 0.56-3.56).
Conclusion : This study revealed that initial extended-release opioid prescriptions for hospitalized cancer patients often did not meet guideline-based appropriateness criteria, with over one-third of ED visits being opioid-related. These findings underscore the necessity for pharmacist-led interventions to enhance opioid prescribing practices and minimize avoidable healthcare utilization. Further research is needed to validate these associations.