肺癌姑息治疗2017年.ppt

* * * * 2012年ESMO（欧洲肿瘤医学会）指南提出——WHO第二阶梯镇痛药物的使用尚存争议，并推荐对于轻中度疼痛，可考虑以低剂量强阿片类药物替代弱阿片类药物与非阿片类药物联合镇痛 * * It is important to understand that the risk of VTE varies not only between this various cancer subgroups but also varies with the natural history of cancer in individual patients themselves. This graph here sort of tries to explain or describe those odds ratios for the risk of VTE at different time points during the natural history of cancer. The risk is always higher in the first few months after diagnosis and this has been documented in multiple population based studies and the risk goes up when patients are receiving chemotherapy or if they are hospitalized either with a complication of chemotherapy or for other reasons such as major surgical interventions. ? We don’t know quite for sure yet, but the risk clearly goes down when cancer patients are in remission. Although it may take several years after the diagnosis of cancer for the risk to approach that in the general population and certainly the risk reverts to high once the cancer recurs, particularly in patients who are metastatic, and again metastatic patients receiving chemotherapy are even at high risk for VTE. * Thrombosis background * Cancer and VTE predict poor outcome This registry-based study from Denmark compared the presence of distant metastases and the 1- year survival in patients who had cancer at the time of an episode of DVT (n=668) with matched controls who had cancer but no DVT (n=6,668) Distant metastases were more common in those with an episode of VTE at the same time as cancer was diagnosed, compared with controls (44% vs 35.1%, prevalence ratio 1.26; 95%?CI?1.13–1.40) Survival rates were significantly worse in those with VTE at the time of cancer diagnosis compared with those without (12% vs 36%; p0.001) Reference 1. Sorensen HT et al. N Engl J Med 2000;343:1846–1850 肿瘤患者合并VTE，死亡风险显著增加。 美国MEDPAR数据库在1988-1990年间的大规模研究显示，在首次入院后3年内，恶性肿瘤合并VTE患者的死亡率高达94%，高于单纯恶性肿瘤患者2倍，单纯VTE患者的3倍 * 数字评估法的疼痛强度