姑息性放疗治疗骨转移疼痛患者的前瞻性监测：一项可行性研究。
Prospective surveillance of patients after palliative radiation for painful bone metastases: a feasibility study.
机构信息
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Internal Medicine, Lousiana State University Health Sciences Center, New Orleans, LA, USA.
出版信息
Ann Palliat Med. 2024 Sep;13(5):1202-1209. doi: 10.21037/apm-24-10. Epub 2024 Sep 12.
BACKGROUND
Bone metastasis is the most common cause of cancer-related pain. Radiation therapy (RT) can provide successful palliation but there is currently no consensus for surveillance after palliative radiation. This study aimed to assess the feasibility of surveillance after RT for painful bone metastases.
METHODS
The study took place in an academic cancer center. Patient feasibility measures included % of calls answered, ease of recruitment and study retention. Clinician measures included % of calls made within 3 days, call time and qualitative feedback. Patients were identified with a painful bone metastasis treated with RT. The bone metastasis had a worst pain score of at least 4 (0-10 scale), with pain localized to a radiographically confirmed lesion. Patients were called at weeks 1, 4 and 8 following RT. Pain response and opioid use were assessed. Quality of life was assessed using a validated questionnaire. Descriptive statistics were used to assess if these metrics were met for patients and clinicians over 8 weeks post-RT.
RESULTS
Twenty patients were consented: 14 participants completed treatment and were not hospitalized or deceased prior to week 1. The patients were 50% male and 50% female. Recruitment was completed quickly, with no patients withdrawing. Response rate was week 1: 85% week 4: 83% and week 8: 83%. Six patients were referred back to their provider for pain management. Calls were made to patients within 3 days a median of 63% of the time (range, 40-82%), with a median call time of 16 (range, 8-42) minutes. Call lengths were longer for patients who required interpretation. Nurse feedback highlighted length of call and nursing time available as limitations.
CONCLUSIONS
All patient feasibility measures were met. Six patients required further pain management, highlighting a need for improved follow up post-RT for bone metastases. Staffing challenges for this intervention must be overcome.
背景
骨转移是癌症相关疼痛最常见的原因。放射治疗（RT）可以提供成功的缓解，但目前对于姑息性放射治疗后的监测尚无共识。本研究旨在评估对疼痛性骨转移进行 RT 后监测的可行性。
方法
该研究在一家学术癌症中心进行。患者可行性措施包括电话接听率、招募的难易程度和研究保留率。临床医生的措施包括在 3 天内打电话的比例、通话时间和定性反馈。患者患有疼痛性骨转移，接受 RT 治疗。骨转移的疼痛评分至少为 4 分（0-10 分），疼痛局限于影像学证实的病变部位。患者在 RT 后第 1、4 和 8 周接受电话随访。评估疼痛反应和阿片类药物的使用情况。使用经过验证的问卷评估生活质量。使用描述性统计评估这些指标是否满足患者和临床医生在 RT 后 8 周的情况。
结果
共同意 20 名患者：14 名参与者完成了治疗，在第 1 周之前没有住院或死亡。患者 50%为男性，50%为女性。招募工作迅速完成，没有患者退出。第 1 周的反应率为 85%，第 4 周为 83%，第 8 周为 83%。6 名患者因疼痛管理问题被转介给他们的医生。在 3 天内，中位数有 63%的时间（范围，40-82%）给患者打电话，平均通话时间为 16 分钟（范围，8-42 分钟）。需要翻译的患者的通话时间较长。护士反馈强调了通话时间和护理时间的长短是限制因素。
结论
所有患者可行性措施均已达到。6 名患者需要进一步的疼痛管理，这突出了姑息性 RT 后对骨转移进行更好的随访的必要性。必须克服这种干预措施的人员配备挑战。
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