Ghoshal Arunangshu, Damani Anuja, Muckaden MaryAnn, Singh Pallavi, Deodhar Jayita, Mohanty Sumita, Viswanath Vidya, Grover Amit, Sanghavi Priti, Bhatnagar Sushma
Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai 400012, India.
Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India.
Ecancermedicalscience. 2022 Dec 2;16:1482. doi: 10.3332/ecancer.2022.1482. eCollection 2022.
Breathlessness is one of the devastating symptoms experienced by patients with advanced cancer and can be very challenging to manage.
To find the point prevalence of dyspnoea in advanced cancer patients presenting to palliative care out-patient clinics, and the usage of opioids in palliation of dyspnoea.
We conducted a prospective observational study among all consecutive patients presenting to the outpatient clinics of six cancer centres in India from different parts of the country. In addition to routinely documented demographic and clinical data from patient charts, study investigators collected information on the Edmonton Symptom Assessment System, Cancer Dyspnoea Scale (CDS) and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15 Palliative Care. We calculated the prevalence of dyspnoea and documented the usage of opioids in palliation of dyspnoea using tests of differences across patient characteristics.
Between May 1, 2019, and April 30, 2020, 5,541 patients were screened for eligibility, and 288 were enrolled (48 patients from each of the six centres). We analysed the data of 288 patients, of which 36.4% had dyspnoea, with 28.5% with moderate to a severe degree (>4/10). Tiredness and loss of appetite were found to have associations with dyspnoea which were statistically significant on multivariate analysis. Standard palliative care management and routine usage of opioids preceded improvement in dyspnoea scores, CDS scores and quality of life scores throughout 7 days.
Dyspnoea is a common symptom in advanced cancer patients, presenting to outpatient clinics, and routine documentation of dyspnoea with appropriate usage of opioids helps in mitigation.
The article suggests that breathlessness is a common problem in advanced cancer patients and opioid prescription preceded symptom improvements in such patients.
呼吸困难是晚期癌症患者经历的极具破坏性的症状之一，且管理起来极具挑战性。
确定到姑息治疗门诊就诊的晚期癌症患者中呼吸困难的时点患病率，以及阿片类药物在缓解呼吸困难方面的使用情况。
我们对来自印度不同地区的六个癌症中心门诊的所有连续就诊患者进行了一项前瞻性观察研究。除了从患者病历中常规记录的人口统计学和临床数据外，研究人员还收集了关于埃德蒙顿症状评估系统、癌症呼吸困难量表（CDS）和欧洲癌症研究与治疗组织生活质量问卷核心15项姑息治疗问卷的信息。我们计算了呼吸困难的患病率，并通过对患者特征差异的检验记录了阿片类药物在缓解呼吸困难方面的使用情况。
在2019年5月1日至2020年4月30日期间，对5541名患者进行了资格筛查，288名患者入组（六个中心各48名患者）。我们分析了288名患者的数据，其中36.4%的患者有呼吸困难，28.5%的患者为中度至重度（>4/10）。在多变量分析中，发现疲劳和食欲不振与呼吸困难有关，且具有统计学意义。在整个7天中，标准的姑息治疗管理和阿片类药物的常规使用先于呼吸困难评分、CDS评分和生活质量评分的改善。
呼吸困难是到门诊就诊的晚期癌症患者的常见症状，对呼吸困难进行常规记录并适当使用阿片类药物有助于缓解症状。
本文表明呼吸困难是晚期癌症患者的常见问题，此类患者在症状改善之前就开始使用阿片类药物处方。
