Bossi Paolo, Pietrzyńska Tatiana, Margarit Ferri César, Mansilla Irene, Tellone Valeria, Fioravanti Sara, Di Loreto Giorgio, Comandini Alessandro
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
Front Pain Res (Lausanne). 2024 Jun 28;5:1388837. doi: 10.3389/fpain.2024.1388837. eCollection 2024.
This study aimed to assess the percentage of patients treated according to the European Society for Medical Oncology (ESMO) 2018 guidelines for breakthrough cancer pain (BTcP) and the impact of guidelines adherence on patients' quality of life (QoL).
Adult opioid-tolerant patients diagnosed with BTcP and locally advanced or recurrent metastatic cancer with a life expectancy of >3 months prospectively were included. Patients were followed up for 28 days.
Of 127 patients included, 37 were excluded due to the impossibility to establish adherence to the ESMO guidelines. Among the evaluable patients [51.1% female; with mean (SD) age of 66.4 (11.8) years], all were adherent. BTcP was diagnosed by the Association for Palliative Medicine algorithm in 47.8% of patients and by clinical experience in 52.2% of patients. The mean number of daily BTcP episodes ranged between 1 and 8, with a mean (95% CI) severity of 7.3 (7.0; 7.6) at week 0 and 6.2 (5.8; 6.6) at week 4. Time to maximum pain intensity was 3-15 min in 52.2% of patients, and BTcP lasted 30-60 min in 14.4% of patients at week 0 and 4.4% of patients at week 4. Mean (95% CI) treatment effectiveness was 6.6 (6.1; 7.1) at week 0 and 7.4 (7.0; 7.8) at week 4. Median (Q1-Q3) patients' global impression of clinical condition was 4.0 (4.0-4.0) at week 0 and 3.0 (2.0-3.0) at week 4.
A clear BTcP assessment and strict follow-up could be crucial to guidelines adherence and for patient's QoL.
本研究旨在评估根据欧洲医学肿瘤学会（ESMO）2018年突破性癌痛（BTcP）指南进行治疗的患者比例，以及遵循指南对患者生活质量（QoL）的影响。
前瞻性纳入诊断为BTcP且患有局部晚期或复发性转移性癌症、预期寿命>3个月的成年阿片类药物耐受患者。对患者进行28天的随访。
在纳入的127例患者中，37例因无法确定是否遵循ESMO指南而被排除。在可评估的患者中（51.1%为女性；平均（标准差）年龄为66.4（11.8）岁），所有患者均遵循指南。47.8%的患者通过姑息医学协会算法诊断出BTcP，52.2%的患者通过临床经验诊断出BTcP。每日BTcP发作的平均次数在1至8次之间，第0周时平均（95%CI）严重程度为7.3（7.0；7.6），第4周时为6.2（5.8；6.6）。52.2%的患者达到最大疼痛强度的时间为3 - 15分钟，第0周时14.4%的患者BTcP持续30 - 60分钟，第4周时为4.4%。第0周时平均（95%CI）治疗有效率为6.6（6.1；7.1），第4周时为7.4（7.0；7.8）。患者对临床状况的总体印象中位数（Q1 - Q3）在第0周时为4.0（4.0 - 4.0），第4周时为3.0（2.0 - 3.0）。
明确的BTcP评估和严格的随访对于遵循指南和患者的生活质量可能至关重要。
