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转载 癌症治疗中应重视症状管理,鼓励患者报告结果

翟笑枫 副主任医师 上海长海医院 中医肿瘤科
2016-01-04 266人已读
翟笑枫 副主任医师
上海长海医院

2015-12-29 来源:医脉通

海军军医大学附属长海医院中医肿瘤科翟笑枫

近期JAMA Oncology发表了一篇评论性文章,回顾了一系列关于目前临床医生对患者症状管理缺失的研究。同时介绍了患者报告结果的可能性,问卷的注意事项,以及未来发展的方向。医脉通报道。


任何一个癌症治疗专家都会很深入的关注患者的症状。事实上,症状管理是肿瘤临床的基础。然而,很多研究显示,有一半以上的症状未得到管理。


近期在JAMA Oncology,Montemurro团队发表了一篇大型前瞻性多中心研究5,研究入组了604位接受新辅助化疗的乳腺癌患者,研究人员要求患者在化疗的第一个周期和第三个周期对10种症状提交自我报告。而临床医生同时也按照标准流程在病理记录上报告患者的症状。临床医生在报告时是看不到患者的报告的。


所有研究中心的患者完成问卷率达到了98%。同时,患者报告中的症状有一半以上被临床医生错过了,包括一些可能导致严重并发症的严重症状。


患者的报告也显示化疗的1-3周期症状也在改变,包括显著加重的味觉障碍和呼吸困难,以及呕吐、腹泻、疼痛的增强。相反的,临床医生仅检测到了加重的呼吸困难。这同样是一项新的发现,说明在症状随治疗变化的过程中,患者报告可以提供非常有价值的信息。


系统性的收集患者的报告不仅能够改善症状发现的情况,同时也能改善临床结果。之前的研究显示,将患者报告整合进日常癌症治疗中,可以提高症状评估的有效性9,患者-临床医生的交流度与满意度10,11,症状控制与生活质量12,13,以及避免急诊14


鉴于这些研究结果,我们应当将患者报告整合到日常治疗中,以提高症状发现和管理,避免症状对疗效和治疗进程的损害。但是具体应当怎样做呢?目前已经开发出了多种以网络为基础的患者自我报告系统,并已经成功的在很多癌症中心和医院运转了15

这些进展将会使我们在临床治疗中可以更广泛的收集和使用患者报告的信息,从而改善患者体验和临床结局。


参考文献


1. Fisch MJ, Lee JW,Weiss M, et al. Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol. 2012;30(16):1980-1988.


2. Mayer DK, Travers D,Wyss A, Leak A,Waller A. Why do patients with cancer visit emergency departments? results of a 2008 population study in North Carolina. J Clin Oncol. 2011;29(19):2683-2688.


3. Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008;16(7):791-801.


4. Di MaioM, Gallo C, Leighl NB, et al. Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials. J Clin Oncol. 2015;33(8):910-915.


5. Montemurro F, Mittica G, Cagnazzo C, et al. Self-evaluation of adjuvant chemotherapy-related adverse effects by patients with breast cancer [published online December 23, 2015]. JAMA Oncol. doi:10.1001/jamaoncol.2015.4720.


6. Fromme EK, Eilers KM, MoriM, Hsieh YC, Beer TM. How accurate is clinician reporting of chemotherapy adverse effects? a comparison with patient-reported symptoms from the Quality-of-Life Questionnaire C30. J Clin Oncol. 2004;22(17):3485-3490.


7. Laugsand EA, SprangersMA, Bjordal K, Skorpen F, Kaasa S, Klepstad P. Health care providers underestimate symptom intensities of cancer patients: a multicenter European study. Health Qual Life Outcomes. 2010;8:104.


8. Atkinson TM, Li Y, Coffey CW, et al. Reliability of adverse symptom event reporting by clinicians. Qual Life Res. 2012;21(7):1159-1164.


9. Santana MJ, Feeny D, Johnson JA, et al. Assessing the use of health-related quality of life measures in the routine clinical care of lung-transplant patients. Qual Life Res. 2010;19(3):371-379.


10. Detmar SB, MullerMJ, Schornagel JH,Wever LD, Aaronson NK. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA. 2002;288(23):3027-3034.


11. Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol. 2004;22(4):714-724.


12. Valderas JM, Kotzeva A, EspallarguesM, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17(2):179-193.


13. Kotronoulas G, Kearney N,Maguire R, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? a systematic review of controlled trials. J Clin Oncol. 2014;32(14):1480-1501.


14. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. In press.


15. Jensen RE, Snyder CF, Abernethy AP, et al. Review of electronic patient-reported outcomes systems used in cancer clinical care. J Oncol Pract. 2014;10(4):e215-e222.


16. Snyder CF, Aaronson NK, Choucair AK, et al. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res. 2012;21(8):1305-1314.


17. Reeve BB, Mitchell SA, Dueck AC, et al. Recommended patient-reported core set of symptoms to measure in adult cancer treatment trials. J Natl Cancer Inst. 2014;106(7):dju129.


18. Basch E, Abernethy AP. Commentary: encouraging clinicians to incorporate longitudinal patient-reported symptoms in routine clinical practice. J Oncol Pract. 2011;7(1):23-25.


19. Basch E, Snyder C, McNiff K, et al. Patient-reported outcome performance measures in oncology. J Oncol Pract. 2014;10(3):209-211.


20. Wu AW, Kharrazi H, Boulware LE, Snyder CF. Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol. 2013;66(8)(suppl):S12-S20.


原文编译自:Missing Patients’ Symptoms in Cancer Care Delivery—The Importance of Patient-Reported Outcomes. JAMA Oncology Published online December 23, 2015 


 

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