1 Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre, University Pain Centre Maastricht (UPCM), Maastricht, The Netherlands.
2 Department of Anaesthesiology and Pain Management, OLVG, Amsterdam, The Netherlands.
J Palliat Med. 2019 Feb;22(2):157-163. doi: 10.1089/jpm.2018.0281. Epub 2018 Oct 25.
Cancer pain remains a difficult problem, for which opioids are often necessary. At present it is difficult to predict the effectiveness of opioid therapy.
We aim to assess the association between patient characteristics and opioid treatment response in cancer patients, and develop a model to predict probability of response.
We used data from two previously published randomized clinical trials, in which patients with head and neck cancer were treated with fentanyl or methadone (total N = 134).
Treatment success was defined as ≥50% pain reduction at one and five weeks. We analyzed patient characteristics (age, sex, depression, and anxiety), treatment characteristics (having had chemotherapy, radiotherapy, surgery, methadone, or fentanyl) and pain characteristics (neuropathic and nociceptive).
Based on univariable and multivariable regression analyses determinants of therapy success were assessed. Based on these analyses a prediction model was developed.
Our analyses show that one-week therapy success was associated with methadone (odds ratio [OR] = 5.21), duration of pain in months (OR = 1.12), neuropathic pain (OR = 3.36), and age of the patient in years (OR = 0.95). Inclusion of these four characteristics into our prediction model resulted in an area under the curve of 81.6%.
Careful analyses of patient attributes, treatment, and pain type of patients with head and neck cancer resulted in a prediction model that allowed to predict short-term pain relief and the opioid treatment response in neuropathic and nociceptive pain owing to cancer.
癌症疼痛仍然是一个难题，通常需要使用阿片类药物。目前，很难预测阿片类药物治疗的效果。
我们旨在评估癌症患者的患者特征与阿片类药物治疗反应之间的关系，并建立一个预测反应概率的模型。
我们使用了先前发表的两项随机临床试验的数据，其中接受芬太尼或美沙酮治疗的头颈部癌症患者（共 134 例）。
治疗成功定义为第 1 周和第 5 周疼痛减轻≥50%。我们分析了患者特征（年龄、性别、抑郁和焦虑）、治疗特征（接受过化疗、放疗、手术、美沙酮或芬太尼）和疼痛特征（神经病理性和伤害感受性）。
基于单变量和多变量回归分析，评估治疗成功的决定因素。基于这些分析，我们开发了一个预测模型。
我们的分析表明，第 1 周的治疗成功与美沙酮（比值比 [OR] = 5.21）、疼痛持续时间（OR = 1.12）、神经病理性疼痛（OR = 3.36）和患者年龄（OR = 0.95）相关。将这四个特征纳入我们的预测模型，曲线下面积为 81.6%。
对头颈部癌症患者的患者属性、治疗和疼痛类型进行仔细分析，得出了一个预测模型，可以预测短期疼痛缓解和神经病理性和伤害感受性疼痛的阿片类药物治疗反应。
