Yamada Masami, Matsumura Chikako, Jimaru Yumi, Ueno Rie, Takahashi Kazushige, Yano Yoshitaka
Department of Pharmacy, Osaka-fu Saiseikai Noe Hospital.
Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University.
Biol Pharm Bull. 2018;41(6):858-863. doi: 10.1248/bpb.b17-00749.
For improving the QOL of patients diagnosed with cancer, early palliative care is recommended, aiming to minimize pain and opioid-induced side effects. Herein, we evaluated the effect of continuous interventions for pain management and opioid-induced side effects in outpatients with cancer. Pharmacists continuously performed interventions on patients on their hospital visits, starting from the first visit for opioid introduction to intervention via telephone. We recorded their pain patterns and intensities, use of rescue doses, and types and degrees of side effects during these interventions. The physicians were suggested appropriate recommendations for increased doses or alternative opioids when the pharmacists considered the analgesic dose should be titrated. During the study period, palliative care pharmacists conducted 105 interviews for 27 patients (male: 19 and female: 8) with cancer pain. Pain intensities significantly decreased after the pharmacists' continuous intervention, including those from telephone interviews, with their appropriate recommendations and increased opioid doses. Side effects such as nausea and constipation increased or remained unaffected even after the intervention, likely due to the increased opioid doses. Approximately 90% of recommendations for pain control were accepted by the physicians and helped to control the pain intensities. Before starting physician consultations, pharmacists informed the patients that adequate pain control and side effect management were achievable through regular interviews, wherein patient symptoms were monitored and patients received detailed explanations of pharmaceutical care and courteous and continuous counseling.
为提高癌症确诊患者的生活质量,建议开展早期姑息治疗,旨在将疼痛和阿片类药物引起的副作用降至最低。在此,我们评估了针对癌症门诊患者疼痛管理和阿片类药物引起的副作用进行持续干预的效果。药剂师从患者首次就诊引入阿片类药物开始,直至通过电话进行干预,在患者每次就诊时持续对其进行干预。我们记录了这些干预期间患者的疼痛模式和强度、急救剂量的使用情况以及副作用的类型和程度。当药剂师认为应调整镇痛剂量时,会向医生提出增加剂量或更换阿片类药物的适当建议。在研究期间,姑息治疗药剂师对27例(男性19例,女性8例)癌症疼痛患者进行了105次访谈。在药剂师的持续干预后,包括电话访谈以及他们给出的适当建议和增加阿片类药物剂量后,疼痛强度显著降低。恶心和便秘等副作用即使在干预后仍有所增加或未受影响,这可能是由于阿片类药物剂量增加所致。约90%的疼痛控制建议被医生采纳,有助于控制疼痛强度。在开始与医生会诊前,药剂师告知患者,通过定期访谈可以实现充分的疼痛控制和副作用管理,在访谈中会监测患者症状,并向患者详细解释药学服务以及提供礼貌且持续的咨询。