がんの科学と治療

Analysis of the Clinical Management and Quality of Life of frail Patient’s with Cancer and Breakthrough Cancer Pain in Clinical Practice

Abstract

Gemma Soler González1, Juan Pérez Cajaraville2, Silvia Forcano Sanjuan3, José Luis Firvida Pérez4, César Margarit Ferri5, Natividad Martínez Banaclocha6, Antonio Javier Jiménez López7, Ana Cabezón Álvarez7, Ibone Huerta González7, Begoña Soler López8*

Purpose: The purpose of this study was to analyse the clinical management and Quality of Life (QoL) of frail patients with cancer, chronic background pain and Breakthrough Cancer Pain (BTcP) and to assess whether treatment was conditioned by their frailty status.

Methods: This was an observational study in adult frail patients with cancer, chronic background pain and BTcP. Outcomes of interest collected include clinical and sociodemographic data, Karnofsky Performance Status, quality of life (EuroQoL-5D-5L), chronic pain and BTcP characteristics, as well as treatments administered for their control.

Results: A total of 222 patients were included with a mean age of 68 years (range 24-91), 60.5% men, with a mean Karnofsky of 63.2%. The number of daily episodes of BTcP was 3.8 (95% CI 3.3-4.3), with a duration of 34.6 minutes (95% CI 28.8-40.3), and 56.8% had a gradual onset. Opioids were administered to 88.3% of patients for the chronic pain, and to 83.8% for BTcP. The treatment's daily doses administered for chronic pain and BTcP did not differ from those usually recommended. QoL was significantly worst in frail patients with cancer than EuroQol-5D-5L healthy age-matched no frail patients and was related to performance status (p<0.001) and to the social-familial status (p=0.045).

Conclusion: BTP in frail patients with cancer presents with more episodes, of a shorter duration and more gradual onset compared to other published references of patients with BTcP. QoL was seriously affected in this group of patients. No relevant differences were seen in the doses or method of administration of treatments for chronic pain and BTP in frail patients with cancer as compared to the standard recommendations for non-frail patients. Our findings support the importance of the frailty assessment in all patients with BTcP.