Koivu Liisa, Pölönen Tuukka, Stormi Teija, Salminen Eeva
The Faculty of Medicine, University of Turku, Turku, Finland.
Biostatistics, University of Turku, Turku, Finland.
Anticancer Res. 2014 Nov;34(11):6581-4.
Cancer pain management in a hospice setting was studied in the present article. Drug treatments were studied at five time points: at the time of transfer to hospice, at 2nd day, two weeks, and two months following transfer to hospice care, as well as one day before death.
Records of 138 consecutive cancer patients treated in hospice in 2010 were studied regarding the drugs given during their stay. The most common cancer was gastro-intestinal cancer (33%), followed by lung (16%) and breast cancer (11%). Data were collected from patients' records and coded in a validated manner for statistical analysis.
The median length of stay in hospice was 14 days (range=2-376 days). Upon transfer, 63% of patients were administered regularly-dosed opioids, 76.8% during the second day at hospice, and 89.9% of the patients received opioids one day prior to death. A significant change was observed in the more frequent subcutaneous administration during hospice stay (p<0.0001). Break-through pain was recorded on the second day in hospice by 52 % of patients, and by 76% on the day prior to death.
Individual patients' needs determined the dose range, but this was not the case for administration route of strong opioids during hospice care.
本文研究了临终关怀环境下的癌症疼痛管理。在五个时间点对药物治疗进行了研究：转入临终关怀时、转入临终关怀护理后的第2天、两周、两个月以及死亡前一天。
研究了2010年在临终关怀机构接受治疗的138例连续癌症患者住院期间用药的记录。最常见的癌症是胃肠道癌（33%），其次是肺癌（16%）和乳腺癌（11%）。从患者记录中收集数据并进行有效编码以进行统计分析。
临终关怀机构的中位住院时间为14天（范围=2 - 376天）。转入时，63%的患者接受常规剂量阿片类药物治疗，在临终关怀机构的第2天为76.8%，死亡前一天89.9%的患者接受阿片类药物治疗。在临终关怀住院期间皮下给药更为频繁，差异有统计学意义（p<0.0001）。52%的患者在临终关怀机构的第2天记录有爆发痛，死亡前一天为76%。
个体患者的需求决定了剂量范围，但在临终关怀护理期间强效阿片类药物的给药途径并非如此。
