我国癌症病人的疼痛和生活质量的初步调查

A SURVEY OF PAIN AND QUALITY OF LIFE(QOL)OF CANCER PATIENTS IN CHINA

１９９２年我们对我国癌症病人疼痛和生活质量组织了三省市１１单位的前瞻性调查。在１５４３例各类癌症患者中，有７８９例（５１．１％）伴有不同程度的疼痛。早、中、晚期患者伴有疼痛分别占３０％，５０．６％和６６．４％。在所有伴有疼痛的患者中直接由肿瘤本身引起的占７８．６％，其它原因仅占２０％左右，其中伴有两种以上原因的为６．７％。对癌症类型、疼痛性质和部位也作了分析。在３８６例有远处转移的病人中伴有疼痛的为８５％。在各种镇痛方法中，抗肿瘤治疗的例数最多（６１％），其次为镇痛药物（３７％）和中药治疗（２３．４％），针刺和神经阻滞各占１．８％和０．４％。在７８９例有疼痛的病人中，有１９３例（２４．５％）未得到相应治疗，其中近８０％为轻度疼痛，２０％为中度疼痛，仅１例为重度疼痛。按ＷＨＯ三阶梯治疗的１４１例有效率为８７．２％，而且重度疼痛者较多。对生活质量指标的调查，早期病人的平均记分为５０．６±５．９，中期病人为４７．１±７．２，晚期病人为４２．９±８．９。晚期病人的生活质量（ＱＯＬ）较早期病人要差，说明ＱＯＬ与肿瘤的进展有明确的相关关系。

A prospective multicenter survey of pain and quality of life of cancer patients was conducted in 11 hospitals in Beijing, Nanjing,and Nanchang.In total,1534 cancer patients were included in this study. All patients used the same instrument,and all tables were checked by the principal investigators in the hospital before the data were sent to the center for evaluation. The grade of pain was evaluated by both verbal rating scale and visual analgesic scale.All survey was computerizd for further analysis.there were 789(51.1%)patients in different stages with pain. Among them, 679(78.6%)patients were caused by can cancer directly. The methods of pain management included anticancer treatment(481),traditional Chinese medicine(185),acupuncture(14),nerve block(3),analgesics(292),and no treatment in 193 patients. We further divided the 292 patients treated with analgesics into two groups, those who were treated according to the WHO three-step method and those treated in other ways. It is evident that complete relief(CR) and partial relief(PR) for analgesia among those treated by the WHO method was 8 3.6%; while among the others,it was 82.1%(P>0. 05 ). But in paitents with severe pain,the figure for the WHO method was 34.0%, compared with 19.1%for the other group(P<0.01).Side effects were also more common with the WHO method(33%vs 21%).To establish practical and useful parameters to evaluate Chinese patients' quality of life(QOL),we designed a survey with 12 categories for QOL and tested it in cancer patients in different stages.The results showed that the scores on the QOL instrument were correlated with the stage of cancer.