Vieira Cláudia, Fragoso Maria, Pereira Deolinda, Medeiros Rui
Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal.
Research Centre-Molecular Oncology Group-CI, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal.
Oncol Lett. 2019 Mar;17(3):3362-3370. doi: 10.3892/ol.2019.10013. Epub 2019 Feb 4.
The accomplishment of successful pain treatment requires evaluation, characterization and quantification. The present study characterized pain and survival in a cohort of patients with cancer with bone metastasis who were treated with intravenous bisphosphonates. A total of 84 patients self-completed the Brief Pain Inventory (BPI) and 36-Item Short Form Survey (SF-36), between November 2010 and March 2011 with a 5-year survival follow-up as a surrogate marker of cancer burden. The median age was 62 years old (34-85), 64% of patients were female and 58% of these females had breast cancer. In the population, self-reported pain was 91.6%, with 29 patients (34.5%) reporting severe pain (score 7-10). Among these patients, only 13 (44.8%) presented a similar report to that of their clinical files and 5 were undergoing treatment with strong opioids (17.2%). A total of 45 patients (46%) had not been prescribed analgesic drugs, of these patients, 32 were treated with a weak opioid, and 13 with a strong opioid. An association was observed between pain records and the prescribed analgesic (P=0.031). BPI maximum pain and overall survival data were analyzed, and a significant association was identified between male patients presenting severe pain and decreased survival (P=0.004). Male survival was associated with severe pain, which is consistent with other data. The results revealed a skeletal-related events (SRE)-free survival (time elapsed from diagnosis of the first bone metastasis to the first SRE) of 9 months (4.39-13.73, 95% CI) with a statistically significant difference between subgroups of time since diagnosis of bone metastasis (P=0.005). The added value of the present study is the suggestion that complete and accurate pain narratives are mandatory and may contribute to the optimization of analgesia, and may help to increase survival rates. Optimal pain management for patients with cancer remains an urgent requirement.
成功的疼痛治疗需要进行评估、特征描述和量化。本研究对一组接受静脉注射双膦酸盐治疗的骨转移癌患者的疼痛情况和生存率进行了特征描述。2010年11月至2011年3月期间，共有84例患者自行完成了简明疼痛问卷（BPI）和36项简短健康调查（SF - 36），并以5年生存率随访作为癌症负担的替代指标。患者中位年龄为62岁（34 - 85岁），64%为女性，其中58%的女性患有乳腺癌。在该人群中，自我报告疼痛的比例为91.6%，29例患者（34.5%）报告有重度疼痛（评分7 - 10分）。在这些患者中，只有13例（44.8%）的报告与其临床档案记录相符，5例正在接受强效阿片类药物治疗（17.2%）。共有45例患者（46%）未开具镇痛药，其中32例接受弱阿片类药物治疗，13例接受强效阿片类药物治疗。疼痛记录与开具的镇痛药之间存在关联（P = 0.031）。对BPI最大疼痛评分和总生存数据进行分析后发现，出现重度疼痛的男性患者生存率降低，二者之间存在显著关联（P = 0.004）。男性生存率与重度疼痛相关，这与其他数据一致。结果显示，无骨相关事件（SRE）的生存期（从首次诊断骨转移到首次发生SRE的时间）为9个月（4.39 - 13.73，95%CI），自诊断骨转移后的不同时间段亚组之间存在统计学显著差异（P = 0.005）。本研究的附加价值在于提示完整准确的疼痛描述是必要的，可能有助于优化镇痛效果，并可能有助于提高生存率。对癌症患者进行最佳疼痛管理仍然是一项迫切需求。
