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Factors Influencing Pain Medication Preference for Breakthrough Cancer Patients and Their Application to Treatments: Survey on Physicians

돌발성 암성 통증 약물 선택 요인과 사용 경험: 의사 대상 설문조사

  • Shin, Jinyoung (Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Shim, Jae Yong (Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Seo, Min Seok (Department of Family Medicine, Incheon St. Mary's Hospital, Catholic University of Korea) ;
  • Kim, Do Yeun (Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Lee, Juneyoung (Department of Biostatistics, Korea University College of Medicine) ;
  • Hwang, In Gyu (Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Baek, Sun Kyung (Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Choi, Youn Seon (Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine)
  • 신진영 (건국대학교병원 가정의학과) ;
  • 심재용 (연세대학교 의과대학 세브란스병원 가정의학과) ;
  • 서민석 (가톨릭대학교 인천성모병원 가정의학과) ;
  • 김도연 (동국대학교 의과대학 일산병원 혈액종양내과) ;
  • 이준영 (고려대학교 의과대학 의학통계학교실) ;
  • 황인규 (중앙대학교 의과대학 중앙대병원 혈액종양내과) ;
  • 백선경 (경희대학교 의과대학 경희대병원 혈액종양내과) ;
  • 최윤선 (고려대학교 의과대학 구로병원 가정의학과)
  • Received : 2017.09.08
  • Accepted : 2018.01.23
  • Published : 2018.03.01

Abstract

Purpose: The purpose of this study was to assess the factors influencing the rescue medication decisions for breakthrough cancer patients and evaluate treatments using the factors. Methods: Based on the results of an online survey conducted by the Korean Society of Hospice and Palliative Care from September 2014 through December 2014, we assessed the level of agreement on nine factors influencing rescue medication preference. The same factors were used to evaluate oral transmucosal fentanyl lozenge, oral oxycodone and intravenous morphine. Results: Agreed by 77 physicians, a rapid onset of action was the most important factor for their decision of rescue medication. Other important factors were easy administration, strong efficacy, predictable efficacy and less adverse effects. Participants agreed that intravenous morphine produced a rapid onset of action and strong and predictable efficacy and cited difficulty of administration and adverse effects as negative factors. Oral oxycodone was desirable in terms of easy administration and less adverse effects. However, its onset of action was slower than intravenous morphine. While many agreed to easy administration of oral transmucosal fentanyl lozenge, the level of agreement was low for strength and predictability of its efficacy, long-term durability and sleep improvement. Conclusion: Rapid onset of action is one of the important factors that influence physicians' selection of rescue medication. Physicians' assessment of rescue medication differed by medication.

목적: 효과적인 돌발성 통증 조절은 암환자의 기능 유지와 삶의 질 향상에 매우 중요하다. 의사가 돌발성 통증 조절 약물 선택 시 고려하는 요인과 사용 경험에 대해 살펴보고자 한다. 방법: 2014년 9월부터 12월까지 한국 호스피스 완화의료학회에서 전국의 의사대상으로 시행한 온라인 설문 결과를 받아 이차적으로 분석하였다. 돌발성 통증 약물 선택 시 고려하는 사항으로 '빠른 효과 발현', '강력한 효과', '적은 부작용', '투약의 편리성', '장기간 지속적인 효과', '용량 비례하여 예측 가능한 효과', '많은 처방 경험'과 '풍부한 임상 데이터'에 5점 척도로 동의 여부를 조사하였다. 약물사용 경험에 대해서는 경점막 펜타닐, 경구 옥시코돈, 주사제 모르핀에 대해 앞서 언급한 9항목의 동의 척도를 조사하였다. 결과: 77명의 응답자는 빠른 효과를 가장 중요한 돌발성 통증 약물의 선택 요건으로 생각하였다. 그 외, 투약 시 편리성, 강력한 효과, 예측 가능한 효과와 적은 부작용이 중요하다고 응답하였다. 주사제 모르핀은 빠른 효과, 강력하고 예측 가능한 효과가 있으나, 투약의 편리함이나 적은 부작용에 대해서는 응답자 동의율이 낮았다. 경구 옥시코돈은 투약의 편리함이나 적은 부작용이 타 약제보다 우수한 것으로 나타났다. 다만, 빠른 효과는 주사제 모르핀보다 낮은 동의를 받았다. 경점막 펜타닐은 편리하지만, 예측 가능한 효과, 장기간 지속적인 효과와 수면장애 개선 효과에서 낮은 동의를 받았다. 결론: 돌발성 통증 조절 약물의 선택 시 빠른 효과 발현을 최적의 조건으로 꼽았으며, 돌발성 통증 조절 약제에 따라 의사의 사용 경험은 차이를 나타내었다.

Keywords

References

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