常见实体瘤门诊患者共病负担认知与症状之间的关联
Association between patients' perception of the comorbidity burden and symptoms in outpatients with common solid tumors.
作者信息
Ritchie Christine S, Zhao Fengmin, Patel Kanan, Manola Judith, Kvale Elizabeth A, Snyder Claire F, Fisch Michael J
机构信息
Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California.
Jewish Home of San Francisco, San Francisco, California.
出版信息
Cancer. 2017 Oct 1;123(19):3835-3842. doi: 10.1002/cncr.30801. Epub 2017 Jun 13.
BACKGROUND
Cancer patients' symptom burden is commonly attributed to their cancer and treatment. Increasingly, cancer patients have many other chronic comorbid conditions. However, the degree to which these comorbid conditions may contribute to the patient-reported symptom burden is unclear.
METHODS
This study explored the relations between the presence of comorbid conditions, the symptom experience and burden, and the perceived bother from cancer or comorbid conditions in 3106 cancer patients. The associations between the number of comorbidities (identified from current medications), the patient-reported symptom burden (the number of symptoms scored as ≥7 on the 13-item MD Anderson Symptom Inventory physical scale), the patient-reported bother from comorbid conditions and from cancer (from "not at all" to "extremely"), and the clinician-reported difficulty in caring for patients' symptoms were examined.
RESULTS
According to medication lists, 19% of the patients had at least 5 of 12 comorbid conditions. Approximately 39% rated at least 1 symptom as ≥ 7, and this proportion increased with an increasing number of comorbid conditions (48% with ≥ 5 comorbid conditions vs 36% with 1 comorbid condition). One-third of the patients reported moderate or worse bother, and this was significantly associated with an increased number of comorbid conditions (odds ratio [OR], 2.4) and an increased symptom burden (OR, 1.22). Clinician ratings of difficulty in managing patients' symptoms were significantly associated with bother from cancer (OR, 2.0), comorbid conditions (OR, 1.6), and symptom burden (OR, 1.1).
CONCLUSIONS
Comorbidity is common in cancer patients and is associated with a greater symptom burden and clinician reports of difficulty in managing patients' symptoms. Greater attention to comorbid conditions is needed to optimize the symptom management of cancer patients with multimorbidity. Cancer 2017;123:3835-3842. © 2017 American Cancer Society.
背景
癌症患者的症状负担通常归因于其癌症本身及治疗。越来越多的癌症患者还患有许多其他慢性合并症。然而，这些合并症对患者报告的症状负担的影响程度尚不清楚。
方法
本研究探讨了3106例癌症患者中合并症的存在、症状体验与负担，以及癌症或合并症带来的困扰之间的关系。研究了合并症数量（根据当前用药确定）、患者报告的症状负担（在13项MD安德森症状量表身体维度中得分≥7的症状数量）、患者报告的合并症及癌症带来的困扰（从“完全没有”到“极其严重”），以及临床医生报告的管理患者症状的困难程度之间的关联。
结果
根据用药清单，19%的患者患有12种合并症中的至少5种。约39%的患者将至少1种症状评为≥7分，且这一比例随着合并症数量的增加而上升（合并症≥5种的患者中这一比例为48%，而合并症为1种的患者中为36%）。三分之一的患者报告有中度或更严重的困扰，这与合并症数量增加（比值比[OR]，2.4）及症状负担增加（OR，1.22）显著相关。临床医生对管理患者症状困难程度的评分与癌症带来的困扰（OR，2.0）、合并症（OR，1.6）及症状负担（OR，1.1）显著相关。
结论
合并症在癌症患者中很常见，且与更大的症状负担以及临床医生报告的管理患者症状的困难程度相关。需要更加关注合并症，以优化患有多种合并症的癌症患者的症状管理。《癌症》2017年；123:3835 - 3842。©2017美国癌症协会
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