Gupta Ankita, Parmar Bhushan, Arora Minni Hurria, Miriyala Raviteja, Anand Neeru, Ghoshal Sushmita
Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiotherapy and Oncology, Pt. JLNGMCH, Chamba, Himachal Pradesh, India.
Indian J Palliat Care. 2020 Jan-Mar;26(1):66-70. doi: 10.4103/IJPC.IJPC_89_19. Epub 2020 Jan 28.
This audit was done to analyze the factors influencing the use of strong opioids in cancer patients receiving comprehensive palliative care from a tertiary institute.
Case records of patients registered for palliative care at our center in 3 months were retrospectively reviewed and followed up throughout the course of their illness. Demographic factors, prior treatments, social support system, analgesic use at registration, and use of radiation and adjuvant analgesics were recorded. Strong opioid use and their time of initiation were evaluated, and multivariate analysis was used to identify the factors correlating with the above.
After registration, strong opioids were initiated in 16% of the patients. It was observed that patients younger than 55 years and those with visceral metastases and history of use of weak opioids at the time of registration had a higher probability of being started on strong opioids. Factors associated with a significantly longer strong opioid-free interval were having spouse as primary caregiver, presence of skeletal metastases, use of palliative radiotherapy, and low socioeconomic status.
It is certain that the use of strong opioids for adequate analgesia is a necessity for palliative-care patients. However, optimal utilization of adjunctive analgesic modalities, coupled with good supportive care, can minimize the requirement and duration of strong opioid use, especially in developing countries with limited access to specialist palliative care.
本次审计旨在分析影响一所三级医疗机构中接受综合姑息治疗的癌症患者使用强阿片类药物的因素。
回顾性分析了在3个月内于我们中心登记接受姑息治疗的患者的病例记录，并在其整个病程中进行随访。记录了人口统计学因素、既往治疗情况、社会支持系统、登记时的镇痛药物使用情况以及放射治疗和辅助镇痛药物的使用情况。评估了强阿片类药物的使用及其起始时间，并采用多变量分析来确定与上述因素相关的因素。
登记后，16%的患者开始使用强阿片类药物。观察到年龄小于55岁、有内脏转移且登记时使用过弱阿片类药物的患者开始使用强阿片类药物的可能性更高。与强阿片类药物无用药间隔时间显著延长相关的因素包括配偶作为主要照顾者、存在骨转移、使用姑息性放疗以及社会经济地位较低。
对于姑息治疗患者而言，使用强阿片类药物以实现充分镇痛是必要的。然而，优化辅助镇痛方式的使用，并辅以良好的支持性护理，可以将强阿片类药物的使用需求和持续时间降至最低，尤其是在获得专科姑息治疗机会有限的发展中国家。
