Chern B, Joseph D, Joshua D, Pittman K, Richardson G, Schou M, Lowe S, Copeman M, De Abreu Lourenco R, Lynch K
Redcliffe Hospital, Brisbane, Australia.
Support Care Cancer. 2004 Jun;12(6):463-6. doi: 10.1007/s00520-004-0628-z. Epub 2004 Apr 16.
We set out to assess the preference of patients with common cancers involving bone receiving intravenous bisphosphonate therapy for either pamidronate (P) or zoledronic acid (Z) and their preference for the location of the infusion (clinic or home). We also aimed to monitor these patients' renal safety, and to compare their time in clinic to receive P and Z infusions.
Enrolled in the study were 184 patients, and all received initial infusions of Z (so any first infusion reactions did not confound preferences for P). For their second and third infusions, patients were randomized to receive Z then P or P then Z, and questioned on their preferences. For up to 1 year they continued on Z infusions every 3-4 weeks, while their renal safety was monitored. Where practical, later infusions were given at home (rather than in the clinic) and patients questioned on their preferred infusion location. In a convenience subset of 43 patients, clinic use for Z and P infusions was also measured by timing infusions and other procedures.
Of 144 patients who received a third infusion, 138 responded to questions on bisphosphonate preference, and of these 138, 92% (127) preferred Z to P, because shorter infusions caused less disruption to their day. Only 12% of eligible patients (16/138) received home infusions, but 13/14 questioned preferred this location. Among 184 patients, 19 episodes of renal impairment were noted, mostly owing to disease progression (e.g. obstructive uropathy), with none linked to Z therapy. The mean clinic time taken to receive Z and any concomitant therapy was about half that for P (78 vs 161 min).
Cancer patients prefer shorter bisphosphonate infusions-and at home, where practical. Regular Z 4 mg infusions appear to be safe in these patients, with routine monitoring of serum creatinine. Using Z rather than P could save busy cancer centres time and improve patient satisfaction.
我们着手评估接受静脉注射双膦酸盐治疗的常见骨转移癌患者对帕米膦酸（P）或唑来膦酸（Z）的偏好以及他们对输液地点（诊所或家中）的偏好。我们还旨在监测这些患者的肾脏安全性，并比较他们在诊所接受P和Z输液的时间。
184例患者纳入本研究，所有患者均接受了Z的初始输注（因此任何首次输注反应均不会混淆对P的偏好）。对于他们的第二次和第三次输注，患者被随机分配接受先Z后P或先P后Z，并询问他们的偏好。在长达1年的时间里，他们每3 - 4周继续接受Z输注，同时监测其肾脏安全性。在可行的情况下，后续输注在患者家中进行（而非在诊所），并询问患者对首选输液地点的看法。在43例患者的便利性子集中，还通过记录输液时间和其他程序来衡量诊所用于Z和P输注的情况。
在接受第三次输注的144例患者中，138例回答了关于双膦酸盐偏好的问题，在这138例中，92%（127例）更喜欢Z而非P，因为较短的输液对他们日常生活的干扰较小。只有12%的符合条件的患者（16/138）接受了家庭输液，但在接受询问的14例患者中有13例更喜欢这个地点。在184例患者中，记录到19例肾功能损害事件，大多归因于疾病进展（如梗阻性尿路病），无1例与Z治疗相关。接受Z及任何伴随治疗的平均诊所用时约为接受P治疗的一半（78分钟对161分钟）。
癌症患者更喜欢较短的双膦酸盐输液——并且在可行的情况下，更喜欢在家中输液。对于这些患者，定期静脉注射4毫克Z似乎是安全的，需常规监测血清肌酐。使用Z而非P可以节省繁忙癌症中心的时间并提高患者满意度。
