European Competence Center for Ovarian Cancer (EKZE), Department of Gynecology with Center for Oncological Surgery, Charité - University Medicine of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Support Care Cancer. 2020 Apr;28(4):1997-2003. doi: 10.1007/s00520-019-05000-y. Epub 2019 Aug 5.
Aim of this study was to analyze the impact of pain on quality of life and survival in recurrent OC patients.
Raw data including the QLQ-C30 questionnaire from three phase II/III trials ("Topotecan phase III," "Hector," and "TRIAS") conducted by the North-Eastern German Society of Gynecological Oncology (NOGGO) were synthesized and analyzed using logistic and Cox regression analyses.
Data on pain was available for 952 patients out of 1226. Moderate to severe pain, which was defined as pain ≥ 50 in the QLQ-C30 symptom scale, was experienced by more than one-third of patients (36.6%). A total of 31% were taking non-opioid pain medication and 16% opioids. Median age at randomization was 61 years (range 25-84). Most patients (84.7%) were diagnosed in FIGO III/IV. Pain was independent from age, FIGO stage, grading, amount of recurrences, and chemotherapy-free interval. ECOG was significantly worse in patients with pain (p < 0.001). Fatigue, nausea/vomiting, sleeping disorders, and abdominal symptoms such as loss of appetite, diarrhea, and constipation were more frequently found in patients with pain (all p < 0.001). Quality of life was significantly diminished (p < 0.001). Pain was also an independent marker for overall survival (OS). Median OS was 18.2 months in patients with pain compared with 22.0 months in patients without pain (p = 0.013, HR 1.25, 95% confidence interval 1.05-1.48). OS was shorter in patients with pain and without pain medication compared with those on sufficient pain medication, whereas OS was mostly decreased in patients having pain despite pain medication (18.5, 19.6, and 15.0 months respectively; p = 0.026). Progression-free survival and prior treatment discontinuation were not associated with pain.
Best supportive care including sufficient pain medication should be delivered as early as possible because effective pain management is crucial for both quality of life and overall survival in patients with recurrent ovarian cancer.
本研究旨在分析复发性卵巢癌患者疼痛对生活质量和生存的影响。
综合分析了东北德国妇科肿瘤学会（NOGGO）开展的三项 II/III 期试验（“拓扑替康 III 期”、“Hector”和“TRIAS”）的原始数据，这些数据包括来自 QLQ-C30 问卷的原始数据。采用逻辑回归和 Cox 回归分析进行分析。
1226 例患者中，952 例患者有疼痛数据。超过三分之一的患者（36.6%）经历了中度至重度疼痛，定义为 QLQ-C30 症状量表中的疼痛≥50。共有 31%的患者正在服用非阿片类止痛药，16%的患者服用阿片类药物。随机分组时的中位年龄为 61 岁（范围 25-84 岁）。大多数患者（84.7%）诊断为 FIGO III/IV 期。疼痛与年龄、FIGO 分期、分级、复发次数和无化疗间隔无关。有疼痛的患者 ECOG 评分明显较差（p<0.001）。有疼痛的患者更常出现疲劳、恶心/呕吐、睡眠障碍以及腹部症状，如食欲不振、腹泻和便秘（均 p<0.001）。生活质量明显下降（p<0.001）。疼痛也是总生存（OS）的独立标志物。有疼痛的患者中位 OS 为 18.2 个月，无疼痛的患者为 22.0 个月（p=0.013，HR 1.25，95%置信区间 1.05-1.48）。与充分使用止痛药的患者相比，有疼痛且未使用止痛药的患者 OS 更短，而尽管使用了止痛药仍有疼痛的患者 OS 明显缩短（分别为 18.5、19.6 和 15.0 个月；p=0.026）。无进展生存期和既往治疗中断与疼痛无关。
应尽早提供最佳支持性治疗，包括充分的疼痛管理，因为有效的疼痛管理对于复发性卵巢癌患者的生活质量和总体生存至关重要。
