Sharma Kuldeep, Mohanti Bidhu K, Rath Gaura K, Bhatnagar Sushma
Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Indian J Palliat Care. 2009 Jul;15(2):148-54. doi: 10.4103/0973-1075.58462.
Pain is a common primary symptom of advanced cancer and metastatic disease, occurring in 50-75% of all patients. Although palliative care and pain management are essential components in oncology practice, studies show that these areas are often inadequately addressed.
We randomly selected 152 patients receiving palliative radiotherapy (PRT) from October 2006 to August 2008, excluding metastatic bone lesions. Patients' records were studied retrospectively.
A median follow-up of 21 weeks was available for 119 males and 33 females with a median age of 55 years. Maximum (60%) patients were of head and neck cancers followed by esophagus (14%), lung (10%) and others. Dysphagia, growth/ulcer and pain were the chief indications for PRT. Pain was present in 93 (61%) cases out of which, 56 (60%) were referred to pain clinic. All except one consulted pain clinic with a median pain score of 8 (0-10 point scale). Fifty-three of these 56 patients (96%) received opioid-based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only five (3%) cases were referred to a hospice. Twenty-two (14%) cases were considered for radical treatment following excellent response to PRT.
In this selective sample, the standard of analgesic treatment was found to be satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients' follow-up needs to be improved along with future studies evaluating those patients who were considered for further RT till radical dose. Programs to change the patients' attitude towards palliative care, physicians' (residents') training to improve communication skills, and institutional policies may be promising strategies.
疼痛是晚期癌症和转移性疾病常见的主要症状，在所有患者中发生率为50%-75%。尽管姑息治疗和疼痛管理是肿瘤学实践的重要组成部分，但研究表明这些领域往往未得到充分解决。
我们随机选取了2006年10月至2008年8月期间接受姑息性放疗（PRT）的152例患者，排除转移性骨病变。对患者记录进行回顾性研究。
119例男性和33例女性患者的中位随访时间为21周，中位年龄为55岁。最大比例（60%）的患者为头颈癌，其次是食管癌（14%）、肺癌（10%）及其他。吞咽困难、肿物/溃疡和疼痛是PRT的主要适应证。93例（61%）患者存在疼痛，其中56例（60%）被转诊至疼痛门诊。除1例患者外，其余患者均咨询了疼痛门诊，中位疼痛评分为8分（0-10分制）。这56例患者中有53例（96%）接受了阿片类药物治疗，33%的患者疼痛得到充分缓解，40%的患者失访。仅5例（3%）患者被转诊至临终关怀机构。22例（14%）患者在对PRT反应良好后被考虑进行根治性治疗。
在这个选择性样本中，镇痛治疗的标准令人满意。然而，在转诊至疼痛门诊及随后转诊至临终关怀机构方面仍有很大的改进空间。需要改善患者随访情况，并开展未来研究评估那些被考虑接受进一步放疗直至根治剂量的患者。改变患者对姑息治疗态度的项目、提高医生（住院医师）沟通技巧的培训以及机构政策可能是有前景的策略。
