Pain and Symptoms of Cancer: Assessment and Treatment

描述（由申请人提供）：即使有有效的症状管理，癌症相关症状也常常得不到很好的治疗。基于以往的工作，本项目将重点关注良好症状管理的主要障碍-评估不足。减轻症状是晚期肺癌患者的主要治疗目标。这些患者预后差，有疼痛、疲劳和情绪困扰等多种症状。由于越来越多的癌症治疗是在门诊基础上进行的，患者没有症状评估的时间更长。少数民族患者在不良症状评估和管理方面的风险更大。经常使用基于计算机/电话的交互式语音应答（IVR）系统进行评估可以改善评估和管理过程。拟议研究的三个目标是：

DESCRIPTION (provided by applicant): Cancer-related symptoms are often poorly treated even when effective symptom management is available. Based on previous work, this project will focus on a major barrier to good symptom management -- inadequate assessment. Reduction of symptoms is a major treatment goal for patients with advanced lung cancer. These patients have a poor prognosis and multiple symptoms such as pain, fatigue, and emotional distress. As more cancer therapy is done on an outpatient basis, patients go longer without symptom assessment. Minority patients are at greater risk for both poor symptom assessment and management. Frequent assessment using computer/telephone-based interactive voice response (IVR) systems may improve both the assessment and management process. The three objectives of the proposed research are: (1) Using the IVR system, to longitudinally assess the prevalence, severity, and interference caused by multiple symptoms in patients with advanced lung cancer, and to characterize factors, including minority and nonminority membership, that may lead to differences in symptom treatment and outcomes. This study will help identify the most distressing symptoms that these patients have, and when, in the course of the disease, they will be most severe. (2) Based on the longitudinal study, to develop symptom severity thresholds that indicate a need for provider notification, and to modify existing symptom management protocols to help providers respond quickly when notified that a patient is symptomatic. (3) To examine, in a randomized clinical trial, the effectiveness of combining IVR assessment, provider notification, and availability of guidelines in reducing symptom burden in advanced cancer, and to compare the effectiveness of this method between minority and non-minority patients.