Prescription patterns of analgesics in cancer patients with bone metastases in Japan: a retrospective database study.

BACKGROUND: Real-world data on optimal cancer pain management remain scarce. We describe prescription patterns of analgesics in Japanese cancer patients with bone metastases. METHODS: National hospital-based claims data were analyzed. Adults with first diagnosis of cancer during 2015-2019 and first diagnosis of bone metastasis after the initial cancer diagnosis were included. Skeletal-related events (SREs) were identified with disease and receipt codes. RESULTS: Among the 40,507 eligible patients (age [mean ± SD], 69.7 ± 11.7 years), lung (25.3%), prostate (15.6%), breast (10.9%), and colorectal (10.7%) cancers were common primary tumors. Time (mean ± SD) between primary cancer diagnosis and bone metastases was 306.9 ± 490.4 days; median survival time from bone metastases was 483.0 days. Most patients used acetaminophen (62.7%, 117.5 days/year) and nonsteroidal anti-inflammatory drugs (NSAIDs; 75.3%, 170.0 days/year). Commonly used opioids included oxycodone (39.4%; 479.3 days/year), fentanyl (32.5%; 52.6 days/year), morphine (22.1%; 130.9 days/year), and tramadol (15.3%; 143.0 days/year). Internal medicine, surgery, respiratory, urology, and orthopedics treated 19.4%, 18.5%, 17.6%, 17.3%, and 13.0% of patients, respectively. Prescription patterns varied inter-department. Overall, 44.9% of patients developed SRE (bone pain requiring radiation [39.6%] or orthopedic surgery [2.9%]; hypercalcemia, 4.9%; pathological fracture, 3.3%; spinal cord compression, 0.4%). Analgesics use by patients with SREs was 1.8- to 2.2-fold in the postsymptomatic vs the presymptomatic period. SRE patients had numerically lower survival probabilities than non-SRE patients. Opioid use increased considerably in the month before death. CONCLUSION: In Japanese cancer patients with bone metastases, acetaminophen, NSAIDs, and weak or strong opioids were commonly used; their use increased after SREs developed. Opioid use increased closer to death.

Seven new meroditerpenoids, from the marine sponge Strongylophora strongylata, that inhibited the maturation of starfish oocytes.

Seven new meroditerpenoids, strongylophorines 13-19 (1-7), have been isolated together with the four known strongylophorines 2 (8), 3 (9), 4 (10), and 8 (11) by a screening method using oocytes of the starfish Asterina pectinifera from a marine sponge Strongylophora strongylata collected at Iriomote Island, Okinawa, Japan. The structures were assigned according to their spectral data. Ten strongylophorines inhibited the maturation of starfish oocytes in the range 1.1-37.6 microM (IC50), while strongylophorine 4 (10) was not active at 250 microM.