Labori Knut Jørgen, Hjermstad Marianne Jensen, Wester Torunn, Buanes Trond, Loge Jon Håvard
Department of Gastroenterological Surgery, Ullevaal University Hospital HF, Oslo, Norway.
Support Care Cancer. 2006 Nov;14(11):1126-33. doi: 10.1007/s00520-006-0067-0. Epub 2006 Apr 7.
To describe prospectively the prevalence and severity of disease-related symptoms, quality of life (QOL) and need for palliative care in patients with advanced pancreatic cancer.
Fifty-one patients treated for advanced pancreatic cancer filled in the Edmonton Symptom Assessment Scale (ESAS) for symptom registration and the EORTC QLQ-C30 and QLQ-PAN26 quality of life questionnaires at first contact (baseline) and the ESAS in the following consultations. Need for palliative interventions were registered.
Of the 22 women and 29 men (mean age, 62 years), 20 had locally unresectable cancer, 19 had metastatic disease, and 12 had recurrent disease after curative resection. Forty-six patients died during follow-up (median survival, 99 days). At baseline, patients reported significantly impaired QOL on nine of 15 scales/items (p<0.01) relative to the general population. Fatigue, loss of appetite, and impaired sense of well-being were the most troublesome symptoms on the ESAS, measured to 4.4(+/-2.8)/5.3(+/-2.3), 4.4(+/-3.2)/5.9(+/-2.7), and 4.0(+/-2.9)/4.6(+/-2.7) (mean+/-SD) at baseline and 8 weeks before death, respectively. Forty-four of the 51 (86%) initial consultations and 107 (58%) of the 185 follow-ups (124 clinical and 61 phone-calls) resulted in palliative care interventions, most frequently changes in opioid or laxative medication and dietary advice.
Patients with advanced pancreatic cancer develop several distressing symptoms. ESAS was useful for assessment of symptom prevalence and intensity and is a clinically adequate method for symptom control. A multidisciplinary approach is necessary for the best palliation of symptoms at the time of diagnosis and during follow-up.
前瞻性描述晚期胰腺癌患者疾病相关症状的患病率及严重程度、生活质量（QOL）和姑息治疗需求。
51例接受晚期胰腺癌治疗的患者在初次就诊（基线）时填写埃德蒙顿症状评估量表（ESAS）用于症状登记，以及欧洲癌症研究与治疗组织的QLQ - C30和QLQ - PAN26生活质量问卷，并在后续会诊时填写ESAS。记录姑息治疗干预需求。
22例女性和29例男性（平均年龄62岁）中，20例患有局部不可切除癌症，19例有转移性疾病，12例在根治性切除术后复发。46例患者在随访期间死亡（中位生存期99天）。在基线时，相对于一般人群，患者在15个量表/项目中的9个上报告生活质量显著受损（p<0.01）。疲劳、食欲减退和幸福感受损是ESAS上最困扰的症状，在基线时分别为4.4（±2.8）/5.3（±2.3）、4.4（±3.2）/5.9（±2.7）和4.0（±2.9）/4.6（±2.7）（均值±标准差）以及死亡前8周。51例患者中的44例（86%）初次会诊以及185次随访中的107例（58%）（124次临床会诊和61次电话随访）导致了姑息治疗干预，最常见的是阿片类药物或泻药用药的改变以及饮食建议。
晚期胰腺癌患者出现多种令人痛苦的症状。ESAS有助于评估症状患病率和强度，是一种临床适用的症状控制方法。多学科方法对于诊断时和随访期间症状的最佳姑息治疗是必要的。
