Laugsand Eivor Alette, Kaasa Stein, de Conno Franco, Hanks Geoffrey, Klepstad Pål
Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
J Opioid Manag. 2009 Jan-Feb;5(1):11-21. doi: 10.5055/jom.2009.0002.
This study aimed to describe intensity and treatment of symptoms other than pain in European palliative care units.
A total of 3,030 patients, including 2,064 that used an opioid, were included from 143 palliative care centers, in 21 European countries.
Pain was treated with analgesics corresponding to the WHO pain ladder step I (n = 374), II (n = 497), and III (n = 1,567). Frequencies of symptoms observed as moderate or severe were for generalized weakness (50 percent), fatigue (48 percent), anxiety (28 percent), anorexia (26 percent), constipation (18 percent), focal weakness (18 percent), depression (18 percent), and dyspnoea (15 percent). When comparing WHO-groups, cancer diagnoses, metastasis sites, countries, and genders, we found that some of the symptom intensities and treatments differed significantly between subgroups. A majority of patients used drugs for symptom management. Still, more than one-third of patients assessed to have moderate or severe constipation did not receive any treatment. The corresponding numbers for depression, confusion, nausea, vomiting, or anxiety were approaching 40 percent and for poor sleep about 50 percent. Prescription practice of antiemetics, laxatives, and psychotropic drugs varied widely between countries both in terms of preparation and percent of patients receiving a specific treatment.
This survey shows that clinically relevant symptoms are frequent and that one-third to half of the patients with a symptom observed as moderate or severe do not receive any treatment aimed to reduce the symptom intensity. Several symptoms and treatments differed between WHO-groups, cancer diagnoses, metastasis locations, countries, and genders. Prescription practice varied between countries both in terms of medication administered and percent of patients receiving specific treatment.
本研究旨在描述欧洲姑息治疗病房中除疼痛以外的症状强度及治疗情况。
来自21个欧洲国家143家姑息治疗中心的3030例患者被纳入研究，其中2064例使用了阿片类药物。
疼痛治疗采用了与世界卫生组织（WHO）疼痛阶梯第一步（n = 374）、第二步（n = 497）和第三步（n = 1567）相对应的镇痛药。观察到的中度或重度症状的发生率分别为：全身无力（50%）、疲劳（48%）、焦虑（28%）、厌食（26%）、便秘（18%）、局部无力（18%）、抑郁（18%）和呼吸困难（15%）。在比较WHO分组、癌症诊断、转移部位、国家和性别时，我们发现亚组之间的一些症状强度和治疗存在显著差异。大多数患者使用药物进行症状管理。然而，仍有超过三分之一被评估为中度或重度便秘的患者未接受任何治疗。抑郁、意识模糊、恶心、呕吐或焦虑的相应比例接近40%，睡眠不佳的比例约为50%。各国在止吐药、泻药和精神药物的处方实践方面，无论是制剂还是接受特定治疗的患者百分比，差异都很大。
这项调查表明，临床相关症状很常见，三分之一至一半被观察到有中度或重度症状的患者未接受任何旨在减轻症状强度的治疗。WHO分组、癌症诊断、转移部位、国家和性别之间，有几种症状和治疗方法存在差异。各国在给药和接受特定治疗的患者百分比方面的处方实践各不相同。
