Anaesthesia, Intensive Care and Pain Unit, Policlinico Hospital, Bari, Italy.
Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
Cancer Control. 2022 Jan-Dec;29:10732748221133752. doi: 10.1177/10732748221133752.
In cancer patients with limited life expectancy, an implant of an intrathecal (IT) drug delivery system connected to a subcutaneous port (IDDS-SP) has been proposed as a successful strategy, but conflicting results are reported on quality of life (QoL). The aim of this prospective observational study is to report the effects on pain, mood and QoL of an IT combination therapy delivered by an IDDS-SP in malignant refractory pain.
Adult patients in which IT therapy was recommended were recruited. An IT therapy with morphine and levobupivacaine was started: VASPI score, depression and anxiety (evaluated by the Edmonton Symptom Assessment System -ESAS-), the Pittsburgh Sleep Quality Index (PSQI), the 5-level EuroQol 5D version (EQ-5D-5L) and the requirements of breakthrough cancer pain (BTcP) medications were registered, with adverse events rate and the satisfaction of patients scored as Patient Global Impression of Change (PGIC).
Fifty patients, (16 F/34 M) were enrolled (age 69 ± 12). All had advanced cancer with metastasis. The median daily VASPI score was 75, the median depression score was 6, and the median anxiety score was 4, median PSQI was 16. At 28 days, a significant reduction in VASPI score was registered as well as in depression and anxiety item. Also, PSQI decreased significantly. The EQ-5D-5 L showed a significant improvement in all components at 14 and 28 days. Patient Global Impression of Change scores showed high level of satisfaction. A low incidence of adverse events and a reduction in BTCP episodes were also registered.
Intrathecal combination therapy delivered by an IDDS-SP could ensure adequate control of cancer related symptoms, such as pain, depression, anxiety and sleep disturbances. These effects, with low rate of AEs and reduced BTcP episodes, could explain the improvement in QoL and the overall high levels of patients' satisfaction.
在预期寿命有限的癌症患者中，植入椎管内（IT）药物输送系统并连接皮下端口（IDDS-SP）已被提议作为一种成功的策略，但关于生活质量（QoL）的结果却存在冲突。本前瞻性观察研究旨在报告恶性难治性疼痛中通过 IDDS-SP 给予 IT 联合治疗对疼痛、情绪和 QoL 的影响。
招募了推荐 IT 治疗的成年患者。开始 IT 治疗，给予吗啡和左布比卡因：VASPI 评分、抑郁和焦虑（用 Edmonton 症状评估系统-ESAS-评估）、匹兹堡睡眠质量指数（PSQI）、5 级欧洲五维健康量表 5 维度版（EQ-5D-5L）和突破性癌症疼痛（BTcP）药物的需求，并记录不良反应发生率和患者满意度，用患者总体印象变化（PGIC）评分。
共纳入 50 名患者（16 名女性/34 名男性；年龄 69 ± 12 岁），均患有晚期转移性癌症。中位每日 VASPI 评分为 75，中位抑郁评分为 6，中位焦虑评分为 4，中位 PSQI 为 16。28 天时，VASPI 评分、抑郁和焦虑项目评分显著降低，PSQI 显著降低。EQ-5D-5L 在 14 和 28 天时在所有维度上均有显著改善。患者总体印象变化评分显示出高度的满意度。不良反应发生率低，BTCP 发作次数减少。
IDDS-SP 输送的 IT 联合治疗可确保充分控制癌症相关症状，如疼痛、抑郁、焦虑和睡眠障碍。这些效果，加上不良反应发生率低和 BTcP 发作次数减少，可解释 QoL 的改善和患者整体满意度高的原因。
