Gough Nicholas J, Smith Clare, Ross Joy R, Riley Julia, Judson Ian
Palliative Care Department, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
Sarcoma. 2011;2011:325189. doi: 10.1155/2011/325189. Epub 2011 Dec 11.
Introduction. The symptom burden and role of palliative care (PC) in patients with advanced soft tissue sarcoma (STS) are not well defined. Methods. This study retrospectively reviewed both symptoms and PC involvement in patients known to an STS referral centre who died in one calendar year. Results. 81 patients met inclusion criteria of which 27% had locally advanced disease and 73% metastases at initial referral. The median number of symptoms was slowly progressive ranging from 2 (range 0-5) before first-line chemotherapy (n = 50) to 3 (range 1-6) at the time of best supportive care (BSC) decision (n = 48). Pain and dyspnoea were the commonest symptoms. Median overall survival from BSC decision was 3.4 weeks. 88% had PC involvement (either hospital, community, or both) with median time from first PC referral to death of 16 (range 0-110) weeks. Conclusions. Patients with metastatic STS have a significant symptom burden which justifies early PC referral. Pain, including neuropathic pain, is a significant problem. Dyspnoea is common, progressive and appears to be undertreated. Time from BSC decision to death is short, and prospective studies are required to determine whether this is due to overtreatment or very rapid terminal disease progression.
引言。晚期软组织肉瘤（STS）患者的症状负担及姑息治疗（PC）的作用尚不明确。方法。本研究回顾性分析了一家STS转诊中心在一个日历年中死亡患者的症状及PC参与情况。结果。81例患者符合纳入标准，其中27%在初次转诊时为局部晚期疾病，73%有转移。症状数量中位数呈缓慢进展，从一线化疗前的2个（范围0 - 5个，n = 50）增至最佳支持治疗（BSC）决策时的3个（范围1 - 6个，n = 48）。疼痛和呼吸困难是最常见的症状。从BSC决策起的中位总生存期为3.4周。88%的患者接受了PC治疗（包括医院、社区或两者），从首次PC转诊到死亡的中位时间为16周（范围0 - 110周）。结论。转移性STS患者有显著的症状负担，这证明应尽早转诊至PC治疗。疼痛，包括神经性疼痛，是一个重大问题。呼吸困难常见、呈进行性且似乎未得到充分治疗。从BSC决策到死亡的时间很短，需要进行前瞻性研究以确定这是由于过度治疗还是终末期疾病进展非常迅速所致。
