应对胰腺癌姑息治疗中的疼痛和食欲挑战：一项全国性纵向连续队列研究的见解

Navigating pain and appetite challenges in palliative care for pancreatic cancer: insights from a national, longitudinal consecutive cohort study.

作者信息

Sousa Mariana S, Garcia Maja Villanueva, Blanchard Megan, Daveson Barbara, Currow David, Khan Nadia N, Goldstein David, Findlay Merran, Landers Amanda, Agar Meera R

机构信息

Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, PO Box 123Broadway , Sydney, NSW, 2007, Australia.

School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.

出版信息

Support Care Cancer. 2025 Apr 8;33(5):365. doi: 10.1007/s00520-025-09402-z.

DOI:10.1007/s00520-025-09402-z

PMID:40199771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11978711/

Abstract

PURPOSE

Pancreatic cancer poses significant challenges in symptom management. Many people have intractable pain and anorexia which is often not amenable to current available options for palliation. This study aims to outline the longitudinal patterns and assess the burden of distress related to pain and appetite experienced by individuals with pancreatic cancer in people referred to Australian palliative care services.

METHODS

Consecutive national cohort study using point-of-care data on symptom distress in people referred to specialist palliative care services.

RESULTS

From 2013 to 2022, information from 20,558 care episodes involving 15,536 people with pancreatic cancer referred to 203 palliative care services nationally were included. Similar numbers of people were admitted to inpatient and community services, with 69% and 60% reporting distress due to pain and appetite, respectively. Distress extended to sleeping (79%, 82%), nausea (83%, 85%), bowels (80%, 83%), breathing (70%, 77%) and fatigue (77%, 77%) for pain and appetite, respectively. Strongest associations were with psychological/spiritual issues (inpatient OR 1.78, 95% CI 1.66-1.90) and pain severity (community OR 1.51, 95% CI 1.42-1.60) for appetite-related distress and pain severity (inpatient OR 1.60, 95% CI 1.49-1.72; community OR 1.35, 95% CI 1.27-1.44) for pain distress. Trends within the cohort revealed increased mild appetite-related distress (+ 10%) and decreased moderate (- 22%) and severe (- 11%) distress, with similar trends for pain.

CONCLUSION

This study underscores prevalent distress in people with pancreatic cancer in Australian palliative care, highlighting the need for optimised referrals and strategies targeting pain severity, appetite-related concerns and psychological and spiritual aspects for improved care outcomes.

摘要

目的

胰腺癌在症状管理方面带来了重大挑战。许多人患有顽固性疼痛和厌食症，目前可用的姑息治疗方法往往对此无效。本研究旨在概述纵向模式，并评估转介至澳大利亚姑息治疗服务机构的胰腺癌患者所经历的与疼痛和食欲相关的痛苦负担。

方法

采用针对转介至专科姑息治疗服务机构患者的症状痛苦即时护理数据进行连续队列研究。

结果

2013年至2022年期间，纳入了涉及全国203家姑息治疗服务机构的15536名胰腺癌患者的20558次护理事件信息。住院和社区服务的患者人数相近，分别有69%和60%的患者报告因疼痛和食欲而感到痛苦。疼痛和食欲导致的痛苦还延伸至睡眠（分别为79%、82%）、恶心（83%、85%）、肠道（80%、83%）、呼吸（70%、77%）和疲劳（77%、77%）。食欲相关痛苦与心理/精神问题（住院患者比值比1.78，95%置信区间1.66 - 1.90）和疼痛严重程度（社区患者比值比1.51，95%置信区间1.42 - 1.60）关联最强，疼痛痛苦与疼痛严重程度（住院患者比值比1.60，95%置信区间1.49 - 1.72；社区患者比值比1.35，95%置信区间1.27 - 1.44）关联最强。队列中的趋势显示，轻度食欲相关痛苦有所增加（+10%），中度（-22%）和重度（-11%）痛苦有所减少，疼痛情况也有类似趋势。