Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Pain Symptom Manage. 2013 Jan;45(1):23-32. doi: 10.1016/j.jpainsymman.2012.01.009. Epub 2012 Jul 25.
Constipation is often inadequately assessed and underdiagnosed in patients with advanced cancer. Many studies use patient-reported constipation (PRC) as an outcome.
The aim was to compare the accuracy of PRC as compared with the modified Rome III (ROME) criteria and to determine the agreement between PRC, physician assessment of constipation, and objective assessment of constipation by modified ROME criteria among outpatients with advanced cancer.
Patients with advanced cancer attending a supportive care clinic were screened. Constipation was assessed using the modified ROME criteria, patient report (yes or no and rated 0-10; 10=worst possible symptom), and physician assessments (yes or no and rated 0-10).
One hundred patients were enrolled, and 50 of 100 patients (50%) met the modified ROME criteria for constipation. Disagreement between ROME criteria and the patient report (yes/no) was found in 33 patients (33%) and between ROME criteria and the physician assessment (yes/no) in 39 patients (39%). The best combination of sensitivity (0.84) and specificity (0.62) was found with scores ≥3/10 for PRC.
We found a high frequency of constipation. The limited agreement with modified ROME criteria suggests that a patient's self-report as yes or no is not useful for clinical practice. Patient self-rating on a 0 to 10 scale (score of three or greater) seems to be the best tool for constipation screening among this population. More research is needed to identify the best way to assess constipation in patients with advanced cancer.
在晚期癌症患者中，便秘常常评估不足和诊断不足。许多研究使用患者报告的便秘（PRC）作为结果。
本研究旨在比较 PRC 与改良罗马 III （ROME）标准的准确性，并确定在晚期癌症门诊患者中 PRC 与便秘的医生评估和改良 ROME 标准的客观评估之间的一致性。
筛选出参加支持性护理诊所的晚期癌症患者。使用改良 ROME 标准、患者报告（是/否，评分 0-10；10=最严重的症状）和医生评估（是/否，评分 0-10）评估便秘。
共纳入 100 例患者，其中 50 例（50%）符合改良 ROME 标准的便秘。在 33 例患者（33%）中发现 ROME 标准与患者报告（是/否）之间存在不一致，在 39 例患者（39%）中发现 ROME 标准与医生评估（是/否）之间存在不一致。PRC 的得分≥3/10 时，灵敏度（0.84）和特异性（0.62）的最佳组合。
我们发现便秘的频率很高。与改良 ROME 标准的有限一致性表明，患者的自我报告为是/否对于临床实践没有用处。对于该人群，0 到 10 分的自我评分（得分为三或更高）似乎是便秘筛查的最佳工具。需要进一步研究以确定评估晚期癌症患者便秘的最佳方法。
