Prevalence and Predictors of Cognitive Dysfunction in Opioid-Treated Patients With Cancer: A Multinational Study
Prevalence and Predictors of Cognitive Dysfunction in Opioid-Treated Patients With Cancer: A Multinational Study
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DOI：
10.1200/jco.2010.32.6884
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发表时间：
2011-04-01
影响因子：
45.3
通讯作者：
Klepstad, Pal
中科院分区：
文献类型：
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作者：
Kurita, Geana P.;Sjogren, Per;Klepstad, Pal
PurposeTo确定阿片类药物治疗cancer.Patients和MethodsEPOS（欧洲药物遗传学阿片类药物研究）患者的认知功能障碍的患病率和相关因素是一个前瞻性的横断面多中心研究，其中成人癌症患者接受阿片类药物治疗中度或重度疼痛至少3天。认知功能评估采用简易精神状态检查（MMSE）。MMSE评分分为明确的认知功能障碍（评分< 24）、可能的认知功能障碍（评分24-26）和无认知功能障碍（评分> 26）。评估了与认知功能障碍潜在相关的因素。MMSE和解释变量之间的关联进行了有序logistic回归models.ResultsWe包括1,915例癌症患者从17个中心。32.9%的患者MMSE评分小于27分。与其他癌症诊断的患者相比，肺癌患者MMSE评分较低的几率较高（调整后的比值比为1.46; 95%CI为1.09 - 1.95）。与每日剂量低于80 mg的患者相比，每日阿片类药物剂量为400 mg或以上（口服吗啡当量）的患者MMSE评分较低的几率高1.75倍（95% CI，1.25至2.46）。认知功能障碍的其他危险因素是年龄较大，低Karnofsky性能状态（KPS），自诊断以来的时间（< 15个月），以及没有突破性疼痛（BTP）。肺癌、每日阿片类药物剂量400 mg或更多（口服吗啡当量）、年龄较大、KPS低、癌症诊断后时间较短以及无BTP是认知功能障碍的预测因素。J Clin Oncol 29：1297-1303. (C)2011年美国临床肿瘤学会
PurposeTo identify prevalence and associated factors of cognitive dysfunction in opioid-treated patients with cancer.Patients and MethodsEPOS (European Pharmacogenetic Opioid Study) is a prospective cross-sectional multicenter study in which adult patients with cancer who received treatment with opioids for moderate or severe pain for at least 3 days were included. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). MMSE scores were categorized into definite cognitive dysfunction (scores < 24), possible cognitive dysfunction (scores 24-26), and no cognitive dysfunction (scores > 26). Factors potentially associated with cognitive dysfunction were assessed. Associations between MMSE and explanatory variables were analyzed by ordinal logistic regression models.ResultsWe included 1,915 patients with cancer from 17 centers. MMSE scores less than 27 were observed in 32.9% of patients. Patients with lung cancer had higher odds (adjusted odds ratio, 1.46; 95% CI, 1.09 to 1.95) for having lower MMSE scores compared with patients with other cancer diagnoses. Patients receiving daily opioid doses of 400 mg or more (oral morphine equivalents) had 1.75 (95% CI, 1.25 to 2.46) times higher odds of having lower MMSE scores compared with those receiving daily doses less than 80 mg. Other risk factors for cognitive dysfunction were older age, low Karnofsky performance status (KPS), time since diagnosis (< 15 months), and absence of breakthrough pain (BTP).ConclusionOne third of opioid-treated patients with cancer had possible or definite cognitive dysfunction. Lung cancer, daily opioid doses of 400 mg or more (oral morphine equivalents), older age, low KPS, shorter time since cancer diagnosis, and absence of BTP were predictors for cognitive dysfunction. J Clin Oncol 29: 1297-1303. (C) 2011 by American Society of Clinical Oncology