Jamsen Kris M, Turner Justin P, Shakib Sepehr, Singhal Nimit, Hogan-Doran Jonathon, Prowse Robert, Johns Sally, Bell J Simon
Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.
Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
Drugs Real World Outcomes. 2015 Jun;2(2):117-121. doi: 10.1007/s40801-015-0022-9.
Pain management can be challenging in frail older people with cancer due to drug-drug interactions and heightened susceptibility to adverse drug events.
To investigate the relationship between analgesic use and pain by frailty status in older outpatients with cancer.
A total of 385 consecutive patients aged 70 years and over who presented to an outpatient oncology clinic between January 2009 and July 2010 completed structured assessments of analgesic use (opioids, paracetamol or non-steroidal anti-inflammatory drugs), pain (10-point visual analogue scale) and clinical factors. Frailty was derived using modified Fried's frailty phenotype. Logistic regression was used to compute adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for the relationship between analgesic use and pain for each frailty group (robust, pre-frail or frail).
For robust outpatients (n = 101), there was weak evidence for a 30 % relative increase in the adjusted odds of analgesic use between outpatients who differed by one unit of pain score (95 % CI 0.995-1.71, p = 0.0532). For pre-frail outpatients (n = 190), there was evidence for a negative quadratic relationship (adjusted OR for the quadratic coefficient: 0.952, 95 % CI 0.910-0.993, p = 0.0244). For frail outpatients (n = 94), there was an 8 % relative increase in the adjusted odds of analgesic use between outpatients who differed by one unit of pain score, but no statistical evidence for association (95 % CI 0.934-1.26; p = 0.298).
These findings can be considered for the ongoing development of safe, effective strategies for analgesic use in older outpatients with cancer.
由于药物相互作用以及对药物不良事件的易感性增加，癌症老年体弱患者的疼痛管理具有挑战性。
探讨老年癌症门诊患者中，镇痛药物使用与疼痛之间按虚弱状态划分的关系。
2009年1月至2010年7月期间，共有385名70岁及以上的连续患者前往肿瘤门诊就诊，他们完成了关于镇痛药物使用（阿片类药物、对乙酰氨基酚或非甾体抗炎药）、疼痛（10分视觉模拟量表）和临床因素的结构化评估。使用改良的弗里德虚弱表型来确定虚弱状态。采用逻辑回归计算每个虚弱组（强健、脆弱前期或虚弱）中镇痛药物使用与疼痛之间关系的调整优势比（OR）和95%置信区间（CI）。
对于强健的门诊患者（n = 101），疼痛评分相差一个单位的门诊患者之间，镇痛药物使用调整优势比相对增加30%，证据较弱（95% CI 0.995 - 1.71，p = 0.0532）。对于脆弱前期门诊患者（n = 190），存在负二次关系的证据（二次系数的调整OR：0.952，95% CI 0.910 - 0.993，p = 0.0244）。对于虚弱门诊患者（n = 94），疼痛评分相差一个单位的门诊患者之间，镇痛药物使用调整优势比相对增加8%，但无统计学关联证据（95% CI 0.934 - 1.26；p = 0.298）。
在为癌症老年门诊患者制定安全、有效的镇痛策略的持续发展过程中，可以考虑这些研究结果。
