Background: Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency. Materials and Met...
Background: Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency. Materials and Methods: A prospective study was conducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University. Patient records were collected including patient demographics, the disease, treatment characteristics, and details of opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The area under the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measure of opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-point decline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis. Results: In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001), the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in the opioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioids was strongly associated with current cancer treatment (chemotherapy vs. others) (${\beta}=-0.31$, T=-2.81, P=0.007) and the VAS for pain at the time of hospitalisation (${\beta}=-0.34$, T=-3.07, P= 0.003). Conclusions: The pain load, opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit received from opioids in cancer patients.
Background: Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency. Materials and Methods: A prospective study was conducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University. Patient records were collected including patient demographics, the disease, treatment characteristics, and details of opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The area under the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measure of opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-point decline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis. Results: In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001), the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in the opioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioids was strongly associated with current cancer treatment (chemotherapy vs. others) (${\beta}=-0.31$, T=-2.81, P=0.007) and the VAS for pain at the time of hospitalisation (${\beta}=-0.34$, T=-3.07, P= 0.003). Conclusions: The pain load, opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit received from opioids in cancer patients.
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문제 정의
However, pain complexity and the heterogeneity of patient response to opioid analgesics are important barriers for optimal pain control in cancer patients. Therefore, the objective of this study is to identify additional factors that may influence pain-free survival as well as factors that are predictive of patient response to opioid analgesics.
제안 방법
Patients were included in the study, whether they were hospitalized for pain palliation or another reason, if they reported cancer related pain regardless of pain medications they were using. Patient records were collected for information regarding patient age, gender, occupation, social support, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, nutritional status, cancer type, stage, details of previous therapies, reason for hospitalisation, pain localisation, pain treatment details and opioid dosage used.
대상 데이터
Of the 100 patients included in the present study, 63 were male, 37 were female, and the median age of all patients was 56. The most common cancer diagnoses were lung (30%), gastrointestinal (28%), breast (9%) and gynaecologic (9%) cancers, and 89% of patients were diagnosed with tumour metastasis.
The study population included 100 cancer patients who were hospitalised at the medical oncology clinic of Akdeniz University between August 2009 and January 2010. Patients were included in the study, whether they were hospitalized for pain palliation or another reason, if they reported cancer related pain regardless of pain medications they were using.
데이터처리
The statistical significance of the associations between the PPFS and the analysed factors was evaluated by univariate analysis. Factors with P-values less than 0.10 were then tested in a multivariate Cox-regression analysis using a forward stepwise procedure. BMI and AUC were logarithmically transformed prior to their inclusion in the analysis.
BMI and AUC were logarithmically transformed prior to their inclusion in the analysis. Similarly, changes in the VAS while receiving the standard dosage of opioids and its relationship with the factors tested was first evaluated by univariate linear regression analysis, followed by multivariate linear regression analysis using a forward stepwise procedure for factors with P-values less than 0.10. Factors with P-values ≤0.
The statistical significance of the associations between the PPFS and the analysed factors was evaluated by univariate analysis. Factors with P-values less than 0.
이론/모형
Patients asked to report their pain intensity every morning by the nursing staff during the hospitalisation period. The level of pain perception was measured by a patient self-reported visual analogue scale (VAS) for pain intensity on a scale from 0 to 10. Pain burden was defined as the area under the curve (AUC) calculated from VAS-time tables (Parruti et al.
성능/효과
The multivariate model demonstrated that VAS for pain at the time of hospitalisation (ß=-0.34, T=-3.07, P=0.003) and the current cancer treatment regimen (chemotherapy vs. others) (ß=-0.31, T=-2.81, P=0.007) were independently associated with the outcome.
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