Medical Oncology Department, Santa María Nai Hospital, Orense, Spain.
Department of Pharmacology, University of Alcalá de Henares, Madrid, Spain.
Clin Transl Oncol. 2018 Aug;20(8):1061-1071. doi: 10.1007/s12094-017-1826-8. Epub 2018 May 2.
To monitor oncologists' perspective on cancer pain management.
An anonymized survey was conducted in two waves. First, over a convenience sample of oncologists known to be particularly concerned with the management of pain. Second, using a random sample of oncologists.
In total, 73 and 82 oncologists participated in the first and second wave, respectively. Many oncologists reported to have good knowledge of analgesic drugs (95.9%), the mechanism of action of opioids (79.5%), and good skills to manage opioid-related bowel dysfunction (76.7%). Appropriate adjustment of background medication to manage breakthrough pain was reported by 95.5% of oncologists. Additionally, 87.7% (68.3% in the second wave, p = 0.035) of oncologists reported suitable opioid titration practices, and 90.4% reported to use co-adjuvant medications for neuropathic pain confidently. On the other hand, just 9.6% of oncologists participated in multidisciplinary pain management teams, and merely 30.3 and 27.1% reported to routinely collaborate with the Pain Clinics or involve other staff, respectively. Only 26.4% of the oncologists of the second wave gave priority to pain pathophysiology to decide therapies, and up to 75.6% reported difficulties in treating neuropathic pain. Significantly less oncologists of the second wave (82.9 vs. 94.5%, p = 0.001) used opioid rotation routinely.
Unlike in previous surveys, medical oncologists reported in general good knowledge and few perceived limitations and barriers for pain management. However, multi-disciplinary management and collaboration with other specialists are still uncommon. Oncologists' commitment to optimize pain management seems important to improve and maintain good practices.
监测肿瘤学家对癌症疼痛管理的看法。
分两波进行匿名调查。第一波针对特别关注疼痛管理的肿瘤学家进行便利抽样；第二波采用肿瘤学家的随机抽样。
共有 73 名和 82 名肿瘤学家分别参加了第一波和第二波调查。许多肿瘤学家报告说他们对镇痛药物（95.9%）、阿片类药物作用机制（79.5%）和管理阿片类药物相关肠功能障碍的技能（76.7%）有很好的了解。95.5%的肿瘤学家报告说他们会适当调整背景药物来控制爆发性疼痛。此外，87.7%（第二波为 68.3%，p=0.035）的肿瘤学家报告说他们有合适的阿片类药物滴定实践，90.4%的肿瘤学家报告说他们有信心使用辅助药物治疗神经性疼痛。另一方面，只有 9.6%的肿瘤学家参加了多学科疼痛管理团队，只有 30.3%和 27.1%的肿瘤学家分别报告说他们经常与疼痛诊所合作或涉及其他工作人员。只有 26.4%的第二波肿瘤学家优先考虑疼痛病理生理学来决定治疗方案，多达 75.6%的肿瘤学家报告说他们在治疗神经性疼痛方面有困难。第二波中常规使用阿片类药物轮换的肿瘤学家明显较少（82.9% vs. 94.5%，p=0.001）。
与之前的调查不同，肿瘤内科医生总体上报告了良好的知识水平，并且认为疼痛管理的限制和障碍较少。然而，多学科管理和与其他专家的合作仍然不常见。肿瘤学家对优化疼痛管理的承诺似乎对改善和维持良好的实践很重要。
