Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL.
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
Medicine (Baltimore). 2023 Feb 22;102(8):e32888. doi: 10.1097/MD.0000000000032888.
A strong association exists between pain and lung cancer (LC). Focusing on the disparities in pain referral in LC patients, we are aiming to characterize the prevalence and patterns of referrals to pain management (PM) in Stage IV non-small-cell LC (NSLC) and small-cell LC (SCLC). We sampled the National Cancer Database for de novo stage IV LC (2004-2016). We analyzed trends of pain referral using the Cochran-Armitage test. Chi-squared statistics were used to identify the sociodemographic and clinico-pathologic determinants of referral to PM, and significant variables (P < .05) were included in one multivariable regression model predicting the likelihood of pain referral. A total N = 17,620 (3.1%) of NSLC and N = 4305 (2.9%) SCLC patients were referred to PM. A significant increase in referrals was observed between 2004 and 2016 (NSLC: 1.7%-4.1%, P < .001; SCLC: 1.6%-4.2%, P < .001). Patient and disease factors played a significant role in likelihood of referral in both groups. Demographic factors such as gender, age, and facility type played a role in the likelihood of pain referrals, highlighting the gap and need for multidisciplinary PM in patients with LC. Despite an increase in the proportion of referrals to PM issued for terminal stage LC, the overall proportion remains low. To ensure better of quality of life for patients, oncologists need to be made aware of existent disparities and implicit biases.
疼痛与肺癌（LC）之间存在很强的关联性。我们专注于 LC 患者疼痛转介方面的差异，旨在描述 IV 期非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）患者转介至疼痛管理（PM）的频率和模式。我们从国家癌症数据库中抽取了新发 IV 期 LC（2004-2016）患者。我们使用 Cochran-Armitage 检验分析疼痛转介的趋势。卡方检验用于确定转介至 PM 的社会人口学和临床病理决定因素，显著变量（P<0.05）纳入多变量回归模型预测疼痛转介的可能性。共有 17620 例（3.1%）NSCLC 和 4305 例（2.9%）SCLC 患者被转介至 PM。2004 年至 2016 年，转介率显著增加（NSCLC：1.7%-4.1%，P<0.001；SCLC：1.6%-4.2%，P<0.001）。患者和疾病因素在两组中都对转介的可能性有重要影响。性别、年龄和医疗机构类型等人口统计学因素在疼痛转介的可能性方面发挥了作用，突出了 LC 患者在多学科 PM 方面的差距和需求。尽管为终末期 LC 开具的 PM 转介比例有所增加，但总体比例仍然较低。为了确保患者的生活质量得到改善，肿瘤学家需要意识到现存的差异和潜在的偏见。
