Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Pain Symptom Manage. 2012 Sep;44(3):340-50. doi: 10.1016/j.jpainsymman.2011.09.014. Epub 2012 Jun 13.
There is limited published data regarding the outcomes of palliative care consult on cancer pain treatment at the first follow-up visit.
The primary aim of this study was to determine pain treatment response to an outpatient palliative care consultation at the first follow-up visit for patients with cancer pain.
Data from consecutive patients (n=1612) who were referred to the outpatient Supportive Care Center at The University of Texas M. D. Anderson Cancer Center and completed the Edmonton Symptom Assessment System at their initial and subsequent visits from January 2003 to December 2010 were reviewed. All patients received interdisciplinary care led by palliative care specialists following an institutional protocol. Pain treatment response was defined as a ≥2 point or ≥30% reduction from baseline. Using logistic regression models, predictive factors associated with pain treatment response were assessed.
The mean (SD) baseline pain was 5.36 (2.9). Of the 1612 patients, 462 (29%) rated their pain as mild (numeric rating scale [NRS] score 0-3), 511 (32%) as moderate (NRS score 4-6), and 639 (39%) as severe (NRS score 7-10). Almost half (728 of 1612 [45%]) of the patients achieved pain treatment response. However, 228 of 728 (31%) responding patients still had pain ≥4 at the first follow-up visit in 15 days on average. Of the 462 patients with mild pain at baseline, 147 (32%) had worse pain at the first follow-up visit. Factors associated with clinical response were baseline pain intensity (odds ratio [OR] per point 1.4; P<0.01), fatigue (OR per point 1.01; P=0.014), and Edmonton Symptom Assessment System symptom burden (OR per point 1.01; P=0.039).
More than half of the patients with moderate/severe pain were nonresponders, and about one-third of the patients with mild pain had an increase in pain severity to moderate/severe levels at the first follow-up. More frequent follow-up visits, phone calls, and interdisciplinary clinics may improve pain control.
有关姑息治疗咨询对癌症疼痛治疗在首次随访时的结果，目前仅有有限的文献报道。
本研究的主要目的是确定在癌症疼痛患者的首次随访时，门诊姑息治疗咨询对疼痛治疗的反应。
回顾性分析 2003 年 1 月至 2010 年 12 月连续就诊于德克萨斯大学 MD 安德森癌症中心姑息治疗支持中心，并在初诊及随后的就诊时完成埃德蒙顿症状评估系统（ESAS）评估的 1612 例患者的数据。所有患者均根据机构方案接受由姑息治疗专家领导的多学科治疗。疼痛治疗反应定义为与基线相比疼痛至少减轻 2 分或至少减轻 30%。使用逻辑回归模型，评估与疼痛治疗反应相关的预测因素。
患者的基线平均（标准差）疼痛评分为 5.36（2.9）。在 1612 例患者中，462 例（29%）患者的疼痛程度为轻度（数字评分量表[NRS]评分为 0-3），511 例（32%）为中度（NRS 评分为 4-6），639 例（39%）为重度（NRS 评分为 7-10）。1612 例患者中，728 例（45%）患者达到疼痛治疗反应。然而，在平均 15 天的首次随访时，728 例有反应的患者中有 228 例（31%）仍有疼痛≥4。在基线时疼痛程度为轻度的 462 例患者中，147 例（32%）在首次随访时疼痛程度加重至中度或重度。与临床反应相关的因素包括基线疼痛强度（每增加 1 分，比值比[OR]为 1.4；P<0.01）、乏力（OR 每增加 1 分，OR 为 1.01；P=0.014）和 ESAS 症状负担（OR 每增加 1 分，OR 为 1.01；P=0.039）。
中度/重度疼痛患者中超过一半为无反应者，而轻度疼痛患者中约有三分之一在首次随访时疼痛严重程度加重至中度/重度。更频繁的随访、电话沟通和多学科诊疗可能会改善疼痛控制。
