背景与目的:提高晚期非小细胞肺癌患者的生活质量是肿瘤学者关注的问题之一。吉非替尼已广泛用于治疗晚期非小细胞肺癌。本研究探讨吉非替尼对晚期非小细胞肺癌患者生活质量的影响。方法:70例晚期非小细胞肺癌患者,每日口服吉非替尼250mg,直至病情进展或出现严重不良反应。采用欧洲癌症研究和治疗组织(European Organization for Research and Treatment of Cancer,EORTC)简体中文版EORTC QLQ-C30和QLQ-LC13问卷对治疗前、后症状和生活质量的改变进行评价。结果:58例患者(85.3%)完成了问卷调查。治疗前和治疗8周后患者5种功能状态(躯体、角色、情感、认知、社会)的均值分别为52和63,49和56,64和68,60和65,52和61,整体生活质量评分的均值分别为53和60,差异有显著性(P<0.05);治疗前、后全身症状(乏力、食欲不振)的均值分别为61和58,52和48,肺癌相关症状(呼吸困难、咳嗽、咯血、胸痛)的均值分别为55和49,54和47,28和27,29和25,其中乏力、呼吸困难、咳嗽、胸痛的差异有显著性(P<0.05)。治疗后5种功能状态和整体生活质量的有效率均超过50%,全身症状和肺癌相关症状的有效率均超过40%。症状和生活质量的改善与疾病控制相一致。生活质量改善者生存延长。结论:吉非替尼明显改善晚期非小细胞肺癌患者的症状和生活质量。
Objective: Objective: To assess the effect and adverse effects of transdermal fentanyl for elderly patients with cancer pain in China. Methods: A total of 1664 elderly patients (aged 65-90 with mean age of 72.6) with cancer pain enrolled in the multicenter study from 136 institutes in China. Of them, 408 (28.8%) patients were 75 years old or older. All patients received transdermal fentanyl for the management of cancer pain. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment. Results: Baseline mean of pain intensity was 7.34. On day 1, 3, 6, 9 15, and 30, the pain mean scores were decreased to 3.82, 2.80, 2.43, 2.11, 1.83, 1.64 (P=0.000). The effective rate was 97.18%. The mean doses of fentanyl was 31.34 g/h (25-150 g/h) initially, and 40.59 g/h and 47.50 g/h (25-200 g/h) at day 15 and day 30. At treatment day 15, the dose of fentanyl was ranger from 25 to 50 g/h in 91.8% of patients, 75 to 100 g/h in 7.5% patients, and 125 to 200 g/h only in 0.8% patients. The fine quality of life was in 25.4% patients before treatment, and was 71.15% and 73.04% at day 15 and day 30 respectively (P=0.0000). The common side effects were constipation (10.70%), nausea (11.96%), dizzy (6.85%), vomiting (3.85%), sedation (2.40%), Respiratory depression (0.12%). 86.2% patients preferred continue treated by transdermal fentanyl. Conclusions: Transdermal fentanyl for the elderly with cancer pain is effective, safe, convenient, and can improve the quality of life. Transdermal fentanyl can be recommended as a first-line drug for the treatment of elderly patients with moderate to severe cancer pain, and the initial doses is recommended as 25 g/h.
