Symptoms and Prognoses of Patients With Breast Cancer and Malignant Wounds in Palliative Care Units: The Multicenter, Prospective, Observational EASED Study.

Yuma Takeda, Hiroto Ishiki, Shunsuke Oyamada, Hiroyuki Otani, Isseki Maeda, Takashi Yamaguchi, Jun Hamano, Masanori Mori, Tatsuya Morita
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Abstract

Background: This study sought to investigate the symptoms and prognoses of patients with breast cancer and malignant wounds in the palliative care unit setting.

Methods: This study was a sub-group analysis of a multicenter, prospective, observational study. Patients admitted to 23 palliative care units in Japan between January and December 2017 were enrolled. Data of patients with breast cancer were extracted. We compared demographic characteristics, symptoms, and prognoses by breast cancer malignant wound status. The primary outcome was overall survival. Secondary outcomes included Palliative Prognostic Index (PPI) score, malignant wound characteristics, and symptom burden.

Results: Of 1896 patients, 131 (6.9%) had breast cancer. In this cohort, 44 (33.6%) patients had malignant wounds. Most malignant wounds (88%) were on the back and chest. Malignant wounds were associated with skin redness, erosion, necrosis, or fistula. Symptoms included bleeding, exudate, odor, and pain. Twenty-eight patients (63.6%) needed dressing changes and 14 (31.8%) patients experienced bleeding. None died due to bleeding. In the malignant wounds group, 32 (72.8%) patients had used an opioid dose equivalent to 38 mg of oral morphine daily, compared to 25 mg by 57 (65.5%) patients in the non-malignant wounds group (P = .26). Median PPI scores at hospital admission were 4.5 vs 6.5 (P = .08). Median survival was 23 vs 21 days (P = .48).

Conclusions: Patients with malignant wounds had a distinct symptom burden profile and tended to use a higher dose of opioids. The effect of malignant wounds on survival was unclear.

姑息治疗单位乳腺癌和恶性伤口患者的症状和预后:多中心、前瞻性、观察性ease研究
背景:本研究旨在探讨姑息治疗单位设置的乳腺癌和恶性伤口患者的症状和预后。方法:本研究是一项多中心、前瞻性、观察性研究的亚组分析。2017年1月至12月期间,日本23家姑息治疗单位的患者被纳入研究。提取乳腺癌患者的资料。我们比较了乳腺癌恶性伤口状态的人口学特征、症状和预后。主要终点是总生存期。次要结局包括姑息预后指数(PPI)评分、恶性伤口特征和症状负担。结果:1896例患者中,131例(6.9%)发生乳腺癌。在这个队列中,44例(33.6%)患者有恶性伤口。大部分恶性伤口(88%)位于背部和胸部。恶性伤口伴有皮肤红肿、糜烂、坏死或瘘管。症状包括出血、渗出、气味和疼痛。28例(63.6%)患者需要换药,14例(31.8%)患者出现出血。没有人死于出血。在恶性伤口组中,32例(72.8%)患者使用的阿片类药物剂量相当于每日口服吗啡38毫克,而非恶性伤口组中57例(65.5%)患者使用的阿片类药物剂量相当于每日口服吗啡25毫克(P = 0.26)。住院时PPI评分中位数为4.5 vs 6.5 (P = 0.08)。中位生存期分别为23天和21天(P = 0.48)。结论:恶性伤口患者具有明显的症状负担特征,并倾向于使用更高剂量的阿片类药物。恶性伤口对生存率的影响尚不清楚。
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