Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA.
Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA.
Support Care Cancer. 2020 Apr;28(4):1809-1816. doi: 10.1007/s00520-019-05004-8. Epub 2019 Jul 23.
The impact of supportive medications on patient-reported outcomes (PROs) has not been systematically evaluated. We describe the supportive medications used by treatment-naïve lung cancer patients and assess their association with PROs from MD Anderson Symptom Inventory (MDASI).
Treatment-naïve lung cancer patients who completed PROs from MDASI at the initial visit to MD Anderson Cancer Center were included. Medications from the initial visit were abstracted from the electronic medical records system and categorized into therapeutic classes based on U.S. Pharmacopeia v7.0. A chi-square or Mann-Whitney U test was conducted as appropriate.
Among 459 patients, ~ 50% took any analgesics and 25% were on opioids. One-third of patients with moderate-severe pain were not on any analgesics. Patients taking opioids had significantly worse median pain scores (6 vs. 0) compared with those not taking any analgesics (p < 0.0001). Higher proportion of patients with moderate-severe pain took opioids compared with those with mild pain (52% vs. 16%, p < 0.0001). Patients on opioids also reported significantly worse scores for five other cancer-specific core symptoms and all six symptoms rating interference with daily life. Only 15% of patients with higher composite score for depression-related symptoms were on antidepressants. However, patients taking antidepressants did not significantly differ in any individual MDASI symptom scores compared with those not on antidepressants (p = 0.4858).
Our results suggest a need for better screening for pain and depression and optimization of pain management in treatment-naïve lung cancer patients since their poor functional status may result in suboptimal cancer therapy.
支持性药物对患者报告的结果（PROs）的影响尚未系统评估。我们描述了未经治疗的肺癌患者使用的支持性药物，并评估了它们与 MD 安德森症状量表（MDASI）的 PROs 的相关性。
纳入在 MD 安德森癌症中心首次就诊时完成 MDASI PROs 的未经治疗的肺癌患者。从电子病历系统中提取初始就诊时的药物，并根据美国药典第 7.0 版将其分类为治疗类别。根据需要进行卡方检验或曼-惠特尼 U 检验。
在 459 名患者中，约 50%服用了任何止痛药，25%服用了阿片类药物。三分之一的中度至重度疼痛患者未服用任何止痛药。服用阿片类药物的患者的中位疼痛评分明显更差（6 分 vs. 0 分），与未服用任何止痛药的患者相比（p < 0.0001）。与轻度疼痛患者相比，中度至重度疼痛患者服用阿片类药物的比例明显更高（52% vs. 16%，p < 0.0001）。服用阿片类药物的患者还报告了其他五个癌症特定核心症状和所有六个症状对日常生活的干扰评分明显更差。只有 15%的抑郁相关症状综合评分较高的患者服用了抗抑郁药。然而，与未服用抗抑郁药的患者相比，服用抗抑郁药的患者在任何单个 MDASI 症状评分上没有显著差异（p = 0.4858）。
我们的结果表明，需要更好地筛查未经治疗的肺癌患者的疼痛和抑郁情况，并优化疼痛管理，因为他们较差的功能状态可能导致癌症治疗效果不佳。
