Department of Radiotherapy and Oncology, Clinical Hospital Center.
Family Medicine Practice, Rijeka, Croatia.
Clin J Pain. 2018 Dec;34(12):1159-1163. doi: 10.1097/AJP.0000000000000641.
Unrelieved pain is present in a majority of terminal cancer patients. However, the treatment of pain in palliative and hospice care is affected by the lack of validated pain assessment. The goal of this study was to evaluate differences in pain evaluation between terminal cancer patients and physicians and evaluate the pain levels as a survival biomarker.
Patients were evaluated every 7 days for a total of 4 assessments. Physicians evaluated patients' pain on an numeric rating scale (NRS) scale after clinical examination, after which the patients completed NRS, Quality of Life Questionnaire Core 15 Pal (QLQ-C15-PAL), and Edmonton Symptom Assessment System (ESAS) questionnaires.
On average, physicians minimally underestimated the pain level in patients (3.47 vs. 3.94 on an NRS scale). Pain was overestimated in 28% and underestimated in 46% of the patients. However, half of all underestimation was clinically meaningful, compared with 28% of the overestimation. For patients with an NRS score of ≥7, pain underestimation was both clinically and statistically significant (5.56 vs. 8.17). Pain ratings exhibited a very small correlation to survival (up to r=-0.22), limiting their use as a survival biomarker.
Although physicians can accurately assess mild pain in terminal cancer patients in the hospice setting, the underestimation of pain is still clinically significant in almost a quarter of patients, and especially pronounced in patients with higher levels of pain and in female patients. Hence, validated pain assessment is a necessity in hospice care, with the choice of pain evaluation tool dependent on patient and physician preference.
大多数晚期癌症患者都存在未缓解的疼痛。然而，姑息治疗和临终关怀中的疼痛治疗受到缺乏经过验证的疼痛评估的影响。本研究的目的是评估晚期癌症患者和医生之间的疼痛评估差异，并评估疼痛水平作为生存生物标志物。
患者在 4 次评估中每 7 天评估一次。医生在临床检查后根据数字评分量表（NRS）评估患者的疼痛，然后患者完成 NRS、生活质量问卷核心 15 项（QLQ-C15-PAL）和埃德蒙顿症状评估系统（ESAS）问卷。
平均而言，医生对患者的疼痛程度低估（NRS 评分为 3.47 与 3.94）。在 28%的患者中高估了疼痛，在 46%的患者中低估了疼痛。然而，与 28%的高估相比，所有低估中有一半是具有临床意义的。对于 NRS 评分≥7 的患者，疼痛低估在临床和统计学上都有显著意义（5.56 与 8.17）。疼痛评分与生存的相关性很小（最高 r=-0.22），限制了它们作为生存生物标志物的应用。
尽管医生在临终关怀环境中可以准确评估晚期癌症患者的轻度疼痛，但疼痛的低估在近四分之一的患者中仍然具有临床意义，在疼痛程度较高的患者和女性患者中尤其明显。因此，姑息治疗中需要经过验证的疼痛评估，疼痛评估工具的选择取决于患者和医生的偏好。
