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To explore the status of cancer pain management among hospitalized elderly patients.Pain intensity,use of analgesic drugs and incidence of adverse reactions were surveyed for 620 cancer pain patients.And 218 of them were aged over 65 years.The proportions of mild,moderate and severe pain were 29.8％,36.2％ and 34.0％ respectively.And the corresponding rates in young and middle-aged patients were 28.4％,34.8％ and 36.8％ respectively (P ＞ 0.05).In elders with cancer pain,28％ used no analgesic.For severe pain patients,only 71.6％ received potent opioids and 5.4％ nonsteroidal antiinflammatory drugs.And the corresponding rates in young and middle-aged patients were 26.1％,73.0％ and 4.7％ respectively (P ＞ 0.05).The rates of constipation,dysuria and delirium in elderly patient group were higher than young and middle-aged patient group (P ＜ 0.05).Pain management is unsatisfactory and rational uses of analgesic drugs should be strengthened for preventing the relevant adverse reactions.
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Objective To evaluate the efficacy of flurbiprofen axetil for treatment of break-through pain (BTP) in patients with metastatic bone cancer pain.Methods Ninety-seven patients with metastatic bone cancer pain complicated with BTP were randomly divided into morphine group (M group,n =51) and flurbiprofen axetil group (F group,n =46).In group M,immediate release morphine sulfate was given orally,and the single dose for pain relief was about 10％ to 15％ of the daily slow-release dose,and the administration was repeated until BTP was relieved.In group F,flurbiprofen axetil 50 mg was infused intravenously over 30 min,and the maximum dose was 150 mg.The BTP frequency was recorded within one month after the first BTP relief.The drug consump-tion for treatment of primary cancer pain,and adverse reaction were recorded.Results The onset time of flurbiprofen axetil and immediate release morphine sulfate was (18± 9) and (35± 11) min,respectively (P ＜ 0.05).The onset time of BTP treatment was significantly shorter,and the incidence of constipation was lower in group F than in group M (P ＜ 0.05).There was no statistical significance in the BTP frequency between the two groups (P ＞ 0.05).As compared with that before BTP treatment,the drug consumption for treatment of primary cancer pain was significantly increased after treatment in group M (P ＜ 0.05) and no significant changes were found after treatment in group F (P ＞ 0.05).Conclusion Flurbiprofen axetil is safer and more effective in relieving BTP in patients with metastatic bone cancer pain than immediate release morphine sulfate,and it does not affect the drug tolerance for treatment of primary pain.
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Objective: To discuss whether T_2 breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy need radiotherapy, and to determine the corresponding target region. Methods: We retrospectively analyzed 103 breast cancer patients treated in our hospital between 1997 and 1998. All pa-tients underwent radical mastectomy. Of these patients, 44 did not receive irradiation, 59 received irradiation to the internal mammary chain and supraclavicular area. All patients had no intumescent axillary lymph nodes or distant metastasis before radical mastectomy. T-test was used to analyze quantitative data, and ANOVA was used to analyze numerical data. Kaplan-Meier method and Log rank test were employed to calculate and compare the survival rate. Results: The 10-year survival rate was 56.8% in the non-irradiation group and 72.9% in the irradiation group (X~2=2.805, P=0.094). The 10-year disease free survival rate was 50.0% in the non-irradiation group and 64.4% in the irradiation group (X~2=4.063, P=0.044). The 10-year local recurrence rate was 27.3% in the non-irradiation and 10.2% in the irradiation group (X~2=5.112, P=0.035). The 10-year met-astatic rate was 43.2% in the non-irradiation group and 22.0% in the irradiation group (X~2=5.263, P=0.031).The 10-year chest wall recurrence rate in all patients was 7.8%. No patients had recurrence in the internal mammary chain area. Irradiation in the internal mammary chain area was useless and could not increase sur-vival rate and disease free survival rate. Irradiation in the internal mammary chain area was not helpful for re-ducing local recurrence rate or distant metastatic rate. Conclusion: Radiation therapy can reduce local recur-rence rate and metastatic rate in T_2 breast cancer patients with one to three positive axillary lymph nodes, and can increase survival rate and disease free survival rate. Recurrence in the internal mammary chain area is rare. Therefore, it is not necessary to irradiate the internal mammary chain area. We suggest that T_2 breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy should have irradiation to the chest wall and supraclavicular area.
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Objective To analyze the prognostic value of age in patients with early stage breast cancer. Methods The clinical characteristics of 1030 patients with early stage breast cancer (the number of positive axillary lymph nodes was less than 3) were retrospectively reviewed. Of all the patients, 468(stage Ⅰ, n = 227; and stage Ⅱ , n = 241) received breast conserving surgery (BCS) and 562 (stage Ⅰ, n =184; and stage Ⅱ, n= 378) received modified mastectomy. Patients were divided into young-age group (≤35,136 patients), middle-age group (> 35-≤60,738 patients) and old-age group (> 60,156 patients).The number of patients without postoperative radiation therapy after BCS is 16, 60 and 39 in the three groups, respectively. Two-dimensional conventional fractionated radiotherapy was administered. The prognostic value of the tumor size, status of axillary lymph nodes or hormonal receptors, postoperative radiation therapy were analyzed. Results The follow-up rate was 97.86%. Of 795 patients followed up more than 5 years, 110,569 and 116 patients were devided into the three groups, respectively. There were 40, 202 and 87 patients without radiation therapy in the three groups. The 5-year recurrence rates of the three groups were 6. 2%, 8. 7% and 10. 4% (χ2 = 1.14, P= 0.567). The 5-year distant metastasis rates were4.3% , 9.5 % and2. 5% (χ2 = 5.31 , P = 0. 070) . The5 - year survival rates were9l. 2% , 92. 6%and 82. 1% (χ2 = 6. 83, P = 0.033). The young-age group had more tumors smaller than 2. 0 cm (65.4%), less positive axillary lymph nodes (13.2%), poorer differential tumor and less positive hormone acceptors (48.0%). Of patients with tumor larger than 2. 0 cm who had no radiotherapy after BCS, the 5-year survival rates were 94%, 87% and 71% (χ2= 20.69, P= 0.000) in the three groups. The corresponding recurrence rates were 23%, 18% ,7%, (χ2 = 9. 97, P = 0. 007), and distant metastasis rates were23%, 25% and 10% (χ2 =8.51, P=0. 014). Conclusions The age is an important prognostic factor in patients with early stage breast cancer undergoing BCS, but not in those undergoing modified mastectomy.
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Objective To study whether post-operative radiotherapy is necessary for patients with early breast cancer after radical mastectomy. Methods In 1998, 270 early breast cancer patients with 0 -3 pathologically confirmed positive axillary lymph nodes after radical mastectomy were retrospectively ana-lyzed. There were 156 patients with negative lymph node and 114 with 1 -3 positive lymph nodes. The prog-nostic index (PI) was defined as the sum of scores of the tumor size, number of positive axillary lymph nodes, receptor status, surgical margin status, lymphatic thrombi status, pathological grading and age. The PI≥ 4 was considered as high-risk, and PI <4 as the low-risk. Numerical variables were compared using t test and categorical variables were compared using chi-square test. Kaplan-Meier method was used to calcu-late the survival rates, and the Log-rank test was used for the comparison of the survival curves between dif-ferent groups. Results Of the patients with lymph node negative and 1 - 3 positive, the survival rates were 75.0% and 63.2% (χ~2 = 4.40 ,P =0.036), respectively. The corresponding disease-free survival rate, lo-cal recurrence rate, distant metastasis rate were 71.2% and 9.6% (χ~2 = 3.90, P = 0.048), 7.7% and 16.7%(χ~2 =5.22,P=0.022),12.8% and 21.1%(χ~2=3.27,P=0.070), respectively. The mean dis-ease-free survival time of the two groups was 97.03 ± 2.53 months and 87.01 ± 3.80 months, respectively. In the high-risk group, the 10-year survival rates of patients with and without radiotherapy were 72% and 56% (χ~2 = 4.07, P = 0.044), the local recurrence rates were 5% and 24% (χ~2= 11.16, P = 0. 001), and the distant metastasis rates were 16% and 26% (χ~2= 2.18 ,P = 0. 140). In the low-risk group, the survival rate of patients with and without radiotherapy were 81% and 71% (χ~2 = 1.57 ,P = 0.210), the local recur-rence rates were both 11% (χ~2=0.01 ,P=0.975), and the distant metastasis rates were both 13% (χ~2 = 0.00,P = 1. 000). Conclusions Early breast cancer patients with 1 -3 positive axiilary lymph nodes should receive post-operative radiotherapy after radical mastectomy. The prognostic index may decrease the chance of unnecessary radiation by distinguishing the patients under low risk of recurrence from those under high risk.