Implanted intrathecal drug delivery systems may be associated with improved survival in patients with cancer

IF 1.3 Q4 CLINICAL NEUROLOGY British Journal of Pain Pub Date : 2023-10-16 DOI:10.1177/20494637231202089
Alison Mitchell, Lesley Somerville, Nicola Williams, Jonathan McGhie, Alex McConnachie, Gordon McGinn, Jiyoung Lee
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Abstract

Background Intrathecal Drug Delivery Systems (IDDS) are underused in the management of cancer-related pain despite evidence of both efficacy and survival benefit. There is currently limited evidence to indicate which patients might benefit most from IDDS. Aim The aim of the study was to describe the baseline characteristics and survival outcomes of patients who accepted IDDS, patients who declined IDDS and patients who wished to go ahead with IDDS but whose condition deteriorated before they could do so. Design/participants The survival data for 75 consecutive patients who had been offered intrathecal drug delivery were examined as part of a retrospective cohort study. Survival data was compared between three groups: those who accepted intrathecal drug delivery and went on to receive it ( n = 41), those who accepted it but whose condition deteriorated before it commenced ( n = 17) and those who declined this treatment modality ( n = 17). Results Patients who received IDDS survived significantly longer after assessment compared to those who declined IDDS (hazard ratio (HR) for the IDDS group relative to the declined group 0.29 (95% CI 0.16 to 0.53), and 0.23 (95% CI 0.12 to 0.44) after adjustment for gender and baseline functional status. In patients who accepted IDDS but who were unable to commence treatment, survival after assessment was not significantly different from those who declined the IDDS (HR for the deteriorated group relative to the declined group 1.28 (95% CI 0.65 to 2.53), and 0.80 (95% CI 0.65 to 2.53) after adjustment for gender and baseline functional status). Conclusion In this retrospective analysis, an improvement in survival may be associated with patients who accept ongoing pain management with an implanted intrathecal drug delivery system compared to those patients who either declined intrathecal drug delivery or deteriorated before it could be commenced.
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植入式鞘内给药系统可能与癌症患者生存率的提高有关
背景鞘内给药系统(IDDS)在癌症相关疼痛的治疗中应用不足,尽管有证据表明其疗效和生存获益。目前有有限的证据表明哪些患者可能从IDDS中获益最多。本研究的目的是描述接受IDDS的患者、拒绝IDDS的患者和希望继续进行IDDS但病情恶化的患者的基线特征和生存结果。设计/参与者:作为回顾性队列研究的一部分,研究了75例连续接受鞘内给药的患者的生存数据。对三组的生存数据进行比较:接受鞘内给药并继续接受的组(n = 41),接受鞘内给药但在开始前病情恶化的组(n = 17)和拒绝这种治疗方式的组(n = 17)。结果经性别和基线功能状态调整后,接受IDDS治疗的患者在评估后的存活时间明显长于IDDS治疗下降的患者(IDDS组相对于IDDS治疗下降组的风险比(HR)为0.29 (95% CI 0.16 ~ 0.53)和0.23 (95% CI 0.12 ~ 0.44)。在接受IDDS但无法开始治疗的患者中,评估后的生存率与拒绝IDDS的患者无显著差异(恶化组相对于下降组的HR为1.28 (95% CI 0.65至2.53),在调整性别和基线功能状态后为0.80 (95% CI 0.65至2.53))。结论:在这项回顾性分析中,与那些拒绝鞘内给药或在开始前病情恶化的患者相比,接受植入鞘内给药系统进行持续疼痛治疗的患者的生存率可能有所提高。
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来源期刊
British Journal of Pain
British Journal of Pain CLINICAL NEUROLOGY-
CiteScore
3.20
自引率
11.10%
发文量
42
期刊介绍: British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.
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