Kelsen D P, Portenoy R K, Thaler H T, Niedzwiecki D, Passik S D, Tao Y, Banks W, Brennan M F, Foley K M
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
J Clin Oncol. 1995 Mar;13(3):748-55. doi: 10.1200/JCO.1995.13.3.748.
To evaluate the prevalence of pain and depression, their correlation, and their effect on quality of life in patients with recently diagnosed adenocarcinoma of the pancreas (PC).
Cross-sectional pain and psychosocial distress were assessed using validated instruments, including the Memorial Pain Assessment Card (MPAC), Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and Functional Living Index-Cancer (FLIC). Patients were evaluated before their first operation for PC or first treatment with chemotherapy at a large tertiary-care cancer center.
One hundred thirty patients with proven PC were studied: 83 before their operation and 47 before their first chemotherapy treatment. At the time of study entrance, 37% of patients had no pain and an additional 34% had pain that was mild or less severe. Only 29% of patients had moderate, strong, or severe pain. Chemotherapy patients reported significantly more intense pain than did preoperative patients (P = .02). Symptoms of depression were assessed using the BDI and BHS scales. A substantial minority of patients (38%) had BDI scores > or = 15, which suggests high levels of depressive symptoms. There was a significant correlation between increasing pain and depressive symptoms among those who experienced pain. Quality of life was assessed using the Weekly Activity Checklist (WAC) and the FLIC. Compared with patients who had no pain or mild pain, patients with moderate or greater pain had significantly impaired functional activity (P = .03) and poorer quality-of-life scores (P = .02) when compared with those with lesser degrees of pain. There were significant correlations between increasing pain and depression and between pain and depressive symptoms and impaired quality of life and function.
Our results indicate that moderate or severe pain and symptoms of depression are not as prevalent in recently diagnosed PC patients as is generally believed. However, one third have inadequate pain control despite the use of oral analgesics. These patients can be identified by the use of a simple self-report instrument (the MPAC card). Quality of life and function are adversely affected by moderate or greater levels of perceived pain intensity. A simple and rapid assessment is possible and can identify high-risk patients in need of intervention that may improve quality of life.
评估近期诊断为胰腺癌（PC）患者的疼痛和抑郁患病率、它们之间的相关性以及它们对生活质量的影响。
使用经过验证的工具评估横断面疼痛和心理社会困扰，包括纪念疼痛评估卡（MPAC）、贝克抑郁量表（BDI）、绝望量表（BHS）和癌症功能生活指数（FLIC）。在一家大型三级护理癌症中心，对患者在首次接受PC手术前或首次化疗前进行评估。
研究了130例确诊为PC的患者：83例在手术前，47例在首次化疗前。在研究入组时，37%的患者无疼痛，另外34%的患者疼痛轻微或不太严重。只有29%的患者有中度、重度或极重度疼痛。化疗患者报告的疼痛强度明显高于术前患者（P = 0.02）。使用BDI和BHS量表评估抑郁症状。相当一部分患者（38%）的BDI评分≥15，这表明抑郁症状水平较高。在经历疼痛的患者中，疼痛加剧与抑郁症状之间存在显著相关性。使用每周活动清单（WAC）和FLIC评估生活质量。与无疼痛或轻度疼痛的患者相比，中度或更重度疼痛的患者功能活动明显受损（P = 0.03），生活质量得分也比疼痛程度较轻的患者差（P = 0.02）。疼痛加剧与抑郁之间、疼痛和抑郁症状与生活质量及功能受损之间存在显著相关性。
我们的结果表明，近期诊断为PC的患者中，中度或重度疼痛和抑郁症状并不像普遍认为的那样普遍。然而，尽管使用了口服镇痛药，仍有三分之一的患者疼痛控制不佳。使用简单的自我报告工具（MPAC卡）可以识别这些患者。中度或更高水平的感知疼痛强度会对生活质量和功能产生不利影响。进行简单快速的评估是可行的，并且可以识别需要干预以改善生活质量的高危患者。
