疼痛可以預測頭頸部癌症治療病患的存活率


  August 18, 2009 — 根據一項發表於8月號耳鼻喉科頭頸部外科學誌的研究結果,罹患頭頸部癌症病患,相較於發生中重度治療後疼痛病患,有些微或是沒有治療後疼痛與較高的存活率有關。
  
  來自愛荷華市愛荷華大學醫學院的研究團隊報告,特定來說,沒有或是低治療後疼痛病患的5年存活率為81.8%,那些中重度疼痛患者則是65.1%(P=0.04)。
  
  除此之外,嚴重度較高的疼痛與治療後第一年再發有關。那些在治療後第一年內再發的病患,平均疼痛分數顯著高於沒有再發的病患(2.9分相較於1.4分;P=0.006)。
  
  由耳鼻喉、頭頸部外科部Joseph Schaf醫師領導的作者們建議,疼痛發生或是疼痛增加應該促使我們對再發性疾病進行積極檢查。
  
  這項新研究的發現特別重要,作者們寫到,因為頭頸部癌症患者經常未通報治療後疼痛,以及疼痛問題為健康照護提供者所忽視。
  
  這項研究有一個特別需要注意的限制:在病患問卷中,有關於疼痛方面,並未區分頭頸部或其他部位的疼痛。然而,作者們表示,如果與頭頸部癌症無關的疼痛是個顯著的問題,則結果不太可能證實疼痛、再發、以及存活率之間是有關連的。
  
  【研究的詳細內容】
  這項研究來自愛荷華大學頭頸部癌症預後評估計畫,該項計畫於1998年到2001年收納病患。於診斷時、3、6、9與12個月後評估自我通報疼痛狀況。
  
  在每次自我通報時,病患們指出他們在過去4週的疼痛程度,以0~10分評估。在這些分析中,疼痛分數以無(0分)、低(1-3分)、中(4-6分)或是高(7-10分)定義。
  
  在這項分析中的339位病患,大部分有原發性疾病(84.4%),或是末期疾病(59.9%),最常見的惡性腫瘤是口腔(42.2%)或是鼻咽(23.3%)腫瘤。大部分病患僅接受外科治療(37.2%)或合併外科手術與放射線治療(37.7%)。大約13%受試者僅接受放射線治療;少數病患接受任何形式的化學治療。
  
  研究結果顯示,在第一年的後續追蹤,疼痛程度的趨勢:3個月時的平均疼痛程度為2.7降到12個月時的1.6。未報告疼痛的百分比從治療前的45.9%降到12個月的61.4%。然而,大約10%病患表示在後續追蹤的1年間有高程度的疼痛。
  
  【讓工作人員收集疼痛資訊】
  研究結果也顯示,高程度疼痛與診斷時年齡較輕、一般生理及精神健康較差、憂鬱症狀較嚴重、以及5年存活率以及1年內再發率有關。
  
  作者們表示,監視疼痛應該是常規癌症後續監視的一部分。作者們寫到,聯合委員會的要求是疼痛應該列為第五個生命徵象,可能提供紀錄疼痛的方式,且隨著時間確認疼痛程度的變化。
  
  應該由誰來進行這項評估呢?作者們建議應該由醫師以外的工作人員,因此病患可能可以更自由地與他們溝通這個抱怨。
  
  這項研究部份由國家衛生研究院、癌症存活病患辦公室贊助。作者們表示沒有相關資金上的往來。
  

Pain Predicts Survival After Head and Neck Cancer Treatment

By Nick Mulcahy
Medscape Medical News

August 18, 2009 — Patients with head and neck cancer who experience little or no posttreatment pain have a higher survival rate than those who experience an intermediate or high level of posttreatment pain, according to a study in the August issue of the Archives of Otolaryngology–Head & Neck Surgery.

Specifically, the 5-year survival rate was significantly higher for patients with no/low posttreatment pain, at 81.8% compared with 65.1% for those with intermediate/high pain (P = .04), reported investigators from the University of Iowa College of Medicine in Iowa City.

In addition, a higher pain level was associated with recurrence in the first year after treatment. The mean pain score for those who experienced recurrence in the first year was significantly greater than the mean score of those who did not have recurrence (2.9 vs 1.4; P = .006).

"The onset of pain or an increase in pain should therefore prompt an aggressive workup for recurrent disease," advise the authors, led by Joseph Scharf, MD, from the department of otolaryngology, head and neck surgery.

The onset of pain or an increase in pain should therefore prompt an aggressive workup for recurrent disease

The new study's findings are especially important, write the authors, because posttreatment pain has often been "underreported by patients with head and neck cancer and marginalized by health care providers."

The study has one limitation that is of particular note: the single item on a patient questionnaire that captured pain did not differentiate between head and neck pain and other bodily pain. However, the authors note that it is "unlikely" that results would have shown an association among pain, recurrence, and survival if pain unrelated to the head and neck cancer was a "substantial problem."

Study Details

The new study comes from the University of Iowa's Head and Neck Cancer Outcomes Assessment Project, which enrolled patients between 1998 and 2001. Self-reported pain was measured at diagnosis and 3, 6, 9, and 12 months later.

At each self-report, patients indicated their average level of pain during the previous 4 weeks, using a scale from 0 to 10. In the analyses, pain scores were presented as none (0), low (1 – 3), intermediate (4 – 6), or high (7 – 10).

Of 339 patients in the analysis, most had primary disease (84.4%) or advanced-stage disease (59.9%), and the most common malignancies were oral cavity (42.2%) or laryngeal (23.3%) tumors. Most of the patients received either surgical treatment alone (37.2%) or surgery combined with radiotherapy (37.7%). About 13% received radiation alone; very few patients received any form of chemotherapy.

The results revealed trends in pain levels during the first year of follow-up: the mean pain level decreased from 2.7 at 3 months to 1.6 at 12 months. The percentage of patients reporting no pain increased from 45.9% at pretreatment to 61.4% at 12 months. However, about 10% of patients reported high levels of pain throughout the 1-year period.

Let Staff Collect Pain Information

The study results also indicated that a higher level of pain was also associated with younger age at diagnosis, worse general physical and mental health, and higher levels of depressive symptoms, as well as 5-year survival rate and recurrence within the first year.

Monitoring pain should be part of routine oncologic surveillance, note the authors. "The Joint Commission's requirement that pain be assessed as a 'fifth vital sign' may provide the means for documenting pain and identifying changes in pain levels across time," the authors write.

The Joint Commission's requirement that pain be assessed as a 'fifth vital sign' may provide the means for documenting pain

Who should perform this assessment? The authors suggest that it should be staff other than the physician, so that "patients might more freely communicate this complaint."

The study was supported in part by a grant from the National Institutes of Health, Office of Cancer Survivorship. The authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2009;135[8]:789–794.

    
相關報導
不再使用安慰劑:嬰兒使用甜味溶液控制疼痛
2017/1/4 下午 02:06:50
慢性疼痛戰役-接受與靈活療法
2016/6/15 下午 05:10:48
音樂可以改善一些術後結果
2015/8/31 下午 05:28:13

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁