Riechelmann Rachel P, Krzyzanowska Monika K, O'Carroll Aoife, Zimmermann Camilla
Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada.
Support Care Cancer. 2007 Dec;15(12):1407-12. doi: 10.1007/s00520-007-0253-8. Epub 2007 Apr 12.
Patients with advanced cancer frequently experience distressful symptoms and receive numerous medications. We describe the symptomatology and medication profile of ambulatory cancer patients receiving exclusively supportive care at the Princess Margaret Hospital.
This was a retrospective, cross-sectional study. We reviewed the charts of consecutive adult cancer patients attending palliative care clinics and who were no longer receiving cancer-directed therapy. From the medical records, we collected information about self-reported symptoms [screened for with the numerical Edmonton symptom assessment system (ESAS) scale; range, 0-10, with 10=worst symptom] and medication profiles. Summary statistics were used to describe the results.
Two hundred fifty five patients met the inclusion criteria. The most frequent self-reported symptoms of any severity were fatigue (77%), pain (75%), and lack of appetite (66%). These were also the most severe symptoms: fatigue (median ESAS score=7), pain (median ESAS=5), and lack of appetite (median ESAS=5). The median number of medications per patient after consultation in the palliative care service was 6, and the most common classes of drugs prescribed were opioids (67%), laxatives/stool softeners (54%), corticosteroids (41%), and acetaminophen (41%). Palliative care physicians made at least one medication change in 75% of the patients, with the most frequent change being the addition of new medication(s); dexamethasone was the most commonly added individual drug (18% of the patients).
Among patients with advanced cancer not receiving antineoplastic therapy, the most frequent and severe symptoms were fatigue, pain, and lack of appetite. The medication profile represented drugs that could both alleviate and contribute to these symptoms. Audit of patient symptoms and medication prescription in palliative care may inform clinical practice and help the development of research specific to patient symptoms.
晚期癌症患者经常出现令人痛苦的症状，并服用多种药物。我们描述了在玛格丽特公主医院仅接受支持性治疗的门诊癌症患者的症状学和用药情况。
这是一项回顾性横断面研究。我们查阅了连续就诊于姑息治疗诊所且不再接受癌症针对性治疗的成年癌症患者的病历。从医疗记录中，我们收集了关于自我报告症状[使用埃德蒙顿症状评估系统（ESAS）数字量表进行筛查；范围为0 - 10，10表示最严重症状]和用药情况的信息。采用汇总统计来描述结果。
255名患者符合纳入标准。任何严重程度下最常自我报告的症状是疲劳（77%）、疼痛（75%）和食欲缺乏（66%）。这些也是最严重的症状：疲劳（ESAS中位数评分 = 7）、疼痛（ESAS中位数 = 5）和食欲缺乏（ESAS中位数 = 5）。在姑息治疗服务咨询后，每位患者的用药中位数为6种，最常开具的药物类别是阿片类药物（67%）、泻药/大便软化剂（54%）、皮质类固醇（41%）和对乙酰氨基酚（41%）。姑息治疗医生在75%的患者中至少进行了一次用药调整，最常见的调整是添加新药物；地塞米松是最常添加的单一药物（占患者的18%）。
在未接受抗肿瘤治疗的晚期癌症患者中，最常见和严重的症状是疲劳、疼痛和食欲缺乏。用药情况显示出既能缓解这些症状又可能导致这些症状的药物。对姑息治疗中患者症状和用药处方的审核可能为临床实践提供参考，并有助于开展针对患者症状的研究。
