Racial differences in pain during 1 year among women with metastatic breast cancer - A hazards analysis of interval-censored data
Racial differences in pain during 1 year among women with metastatic breast cancer - A hazards analysis of interval-censored data
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DOI：
10.1002/cncr.23133
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发表时间：
2008-01-01
期刊：
影响因子：
6.2
通讯作者：
Abernethy, Amy P.
中科院分区：
文献类型：
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作者：
Castel, Liana D.;Saville, Benjamin R.;Abernethy, Amy P.
背景贯穿疾病轨迹的癌症疼痛的纵向肿瘤特异性研究提供了对疼痛过程的洞察。疼痛的预测因素的信息细化我们的理解患者最大的痛苦和需求。作者研究了1124名患有转移性乳腺癌和骨转移的妇女，所有这些人都在1998年10月至2001年1月进行的国际临床试验中接受了标准治疗。在一年的过程中，反复进行简明疼痛量表（BPI）。拟合风险模型，以确定基线和时间依赖性协变量作为一年内累积80天间隔内疼痛恶化的预测因子。增加的重度疼痛风险与非高加索人种（风险比[HR] = 2.52; 95% CI，1.69-3.76）、受限的体能状态（HR = 1.73; 95% CI，1.13-2.64）和既往间期的放射治疗（HR = 2.86; 95% CI，1.61-5.09）相关。未达到BPI 7分或以上的估计累积率范围为0.79（0.72-0.85）（第一个间期）至0.64（0.55-0.74）（最后一个间期），非高加索女性，而这些比率范围为0.91（0.89-0.93）至0.84（0.81-0.87）。通过对癌症症状数据进行时间-事件风险分析，作者证明，非高加索人种预测转移性乳腺癌女性的疼痛控制较差。横断面研究的差异结果得到了证实。疼痛管理策略应考虑种族作为疼痛结局恶化的风险因素，进一步的调查应寻求发现和解决这种明显差异的原因。
BACKGROUND. Longitudinal tumor-specific studies of cancer pain across the disease trajectory provide insight into the course of pain. Information on pain predictors refines our understanding of patients with greatest distress and need.METHODS. The authors studied 1124 women with metastatic breast cancer and bone metastases, all of whom received standard treatment in an international clinical trial conducted from October 1998 to January 2001. The Brief Pain Inventory (BPI) was administered repeatedly during the course of I year. Hazard models were fitted to identify baseline and time-dependent covariates as predictors of pain worsening within cumulative 80-day intervals during the year.RESULTS. increased severe pain hazards were associated with non-Caucasian race (hazard ratio [HR] = 2.52; 95% Cl, 1.69-3.76), restricted performance status (HR = 1.73; 95% Cl, 1.13-2.64), and radiation therapy in a previous interval (HR = 2.86; 95% Cl, 1.61-5.09). Estimated cumulative rates for not yet reaching a BPI score of 7 or above ranged from 0.79 (0.72-0.85) in the first interval to 0.64 (0.55-0.74) in the last interval for non-Caucasian women, whereas these rates ranged from 0.91 (0.89-0.93) to 0.84 (0.81-0.87) for Caucasian women.CONCLUSIONS. By using a time-to-event hazards analysis for cancer symptom data, the authors demonstrated that non-Caucasian race predicted poorer pain control among women with metastatic breast cancer. Disparity findings from cross-sectional studies were confirmed. Pain management strategies should take race into account as a risk factor for worsening pain outcomes, and further investigation should seek to uncover and resolve the reasons for this obvious disparity.