Lazenby James Mark, Saif Muhammad Wasif
Yale University School of Nursing, Yale University School of Medicine, New Haven, CT 06536-0740, USA.
JOP. 2010 Mar 5;11(2):154-7.
Palliative care ought to be offered at the initiation of treatment for people who are diagnosed with pancreatic cancer, given the poor relative survival rate and the intractable symptom profile of those who have this life-limiting disease. In this article, we argue that palliative treatment of people with pancreatic cancer is not found in extending survival, but rather, in promoting quality of life. This argument is made by reviewing the literature on the state of palliative care in pancreatic cancer and by summarizing key studies presented at the "2010 ASCO Gastrointestinal Cancers Symposium" held in Orlando, FL, USA on January 22-24, 2010. The studies discussed here include: i) a study of a random sample of 564 patients with pancreatic cancer that found that the symptom cluster of fatigue and pain predicted survival (Abstract #265); ii) a retrospective study of 108 patients that identified anticoagulation therapy in those who developed portal vein thrombosis prolonged survival (Abstract #143); iii) a double-blind randomized control trial of 50 patients with gastrointestinal cancers who were cachexic in which a thalidomide-olanzapine-megasterol acetate combination attenuated the effects of cancer-anorexia-cachexia syndrome (Abstract #209); iv) a retrospective study on the role of adjuvant chemoradiation and chemotherapy in the treatment of advanced pancreatic cancer (Abstract #230); and v) the benefit of chemotherapy in patients with metastatic pancreatic cancer 80-year-old or more (Abstract #232). Based on the results presented at the meeting, we believe that the discussion of palliative care in the treatment of advanced pancreatic cancer must not conflate the notion of increased survival with increased quality of life, the latter of which is part and parcel of the goal of palliative care. We believe that future study on the effect on quality of life of early palliative-care interventions among people with pancreatic cancer is necessary.
鉴于胰腺癌患者相对生存率较低且患有这种危及生命疾病的患者症状难以控制，在确诊胰腺癌的患者开始治疗时就应提供姑息治疗。在本文中，我们认为，胰腺癌患者的姑息治疗并非在于延长生存期，而是在于提高生活质量。这一观点是通过回顾有关胰腺癌姑息治疗状况的文献，并总结2010年1月22日至24日在美国佛罗里达州奥兰多市举行的“2010年美国临床肿瘤学会胃肠道癌症研讨会”上发表的关键研究而得出的。这里讨论的研究包括：i）一项对564例胰腺癌患者的随机抽样研究，该研究发现疲劳和疼痛症状群可预测生存期（摘要#265）；ii）一项对108例患者的回顾性研究，该研究确定发生门静脉血栓形成的患者接受抗凝治疗可延长生存期（摘要#143）；iii）一项对50例恶病质胃肠道癌症患者的双盲随机对照试验，其中沙利度胺-奥氮平-醋酸甲地孕酮联合用药减轻了癌症恶病质综合征的影响（摘要#209）；iv）一项关于辅助放化疗在晚期胰腺癌治疗中的作用的回顾性研究（摘要#230）；以及v）80岁及以上转移性胰腺癌患者化疗的益处（摘要#232）。基于会议上公布的结果，我们认为，在晚期胰腺癌治疗中讨论姑息治疗时，绝不能将生存期延长与生活质量提高的概念混为一谈，而后者是姑息治疗目标的重要组成部分。我们认为，有必要对早期姑息治疗干预措施对胰腺癌患者生活质量的影响进行进一步研究。
