Prospective, Observational Study of Pain and Analgesic Prescribing in Medical Oncology Outpatients With Breast, Colorectal, Lung, or Prostate Cancer
Prospective, Observational Study of Pain and Analgesic Prescribing in Medical Oncology Outpatients With Breast, Colorectal, Lung, or Prostate Cancer
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DOI：
10.1200/jco.2011.39.2381
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发表时间：
2012-06-01
影响因子：
45.3
通讯作者：
Cleeland, Charles S.
中科院分区：
文献类型：
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作者：
Fisch, Michael J.;Lee, Ju-Whei;Cleeland, Charles S.
目的疼痛在癌症患者中很常见，但门诊肿瘤科的疼痛管理模式了解得很少。患者与方法共有3123名浸润性乳腺癌、前列腺癌、结肠癌/直肠癌或肺癌的门诊患者参加了这项前瞻性研究，无论护理阶段或疾病阶段。在最初的评估和4到5周后，患者完成了对疼痛、功能干预和其他症状的25项测量。提供者记录了止痛药的处方。结果在我们确定的3023名有疼痛风险的患者中，2026名(67%)报告在最初评估时有疼痛或需要止痛药；在这2026名患者中，670名(33%)止痛药处方不足。我们发现初次就诊和后续就诊在治疗充分性方面没有差别。多变量分析显示，在调整了其他解释变量后，非西班牙裔白人患者疼痛治疗不足的几率约为少数族裔患者的一半(优势比，0.51；95%CI，0.37至0.70；P=0.002)。疼痛治疗不充分的其他重要预测因素包括：表现良好、在少数治疗地点接受治疗、患有非晚期疾病而不同时治疗。结论大多数门诊常见实体肿瘤患者都面临与疼痛和止痛药的使用有关的问题。在疼痛治疗充分性方面存在显著差异，少数族裔患者治疗不足的几率是后者的两倍。这些发现持续了一个多月的随访，突显了这些问题的复杂性。
PurposePain is prevalent among patients with cancer, yet pain management patterns in outpatient oncology are poorly understood.Patients and MethodsA total of 3,123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled onto this prospective study regardless of phase of care or stage of disease. At initial assessment and 4 to 5 weeks later, patients completed a 25-item measure of pain, functional interference, and other symptoms. Providers recorded analgesic prescribing. The pain management index was calculated to assess treatment adequacy.ResultsOf the 3,023 patients we identified to be at risk for pain, 2,026 (67%) reported having pain or requiring analgesics at initial assessment; of these 2,026 patients, 670 (33%) were receiving inadequate analgesic prescribing. We found no difference in treatment adequacy between the initial and follow-up visits. Multivariable analysis revealed that the odds of a non-Hispanic white patient having inadequate pain treatment were approximately half those of a minority patient after adjusting for other explanatory variables (odds ratio, 0.51; 95% CI, 0.37 to 0.70; P = .002). Other significant predictors of inadequate pain treatment were having a good performance status, being treated at a minority treatment site, and having nonadvanced disease without concurrent treatment.ConclusionMost outpatients with common solid tumors must confront issues related to pain and the use of analgesics. There is significant disparity in pain treatment adequacy, with the odds of undertreatment twice as high for minority patients. These findings persist over 1 month of follow-up, highlighting the complexity of these problems.