The Clinical Study On Effects Of Opioids On Survive For Advanced Cancer Patients With Moderate To Sever Pain

【Objective】:To evaluate comprehensively the curative effects of opioids used in the therapy of advanced cancer patients who suffered from moderate to severe pains, and focus on researches into the impacts of opioids on survival time of the patients and their quality of lives. Aims at enabling people to understand opioids correctly and use them rationally, and going further into achieving better quality of lives for advanced cancer patients.【Methods】:Between June 2007 and April 2008, 537 patients were enrolled from the Hospice of the First Affiliated Hospital of Guangxi Medical University, who were with confirmed diagnoses of advanced cancer by clinical, imaging and cytology, and with moderate to severe pains (NRS score≥4 points) associated with tumor. The prospective trial had selected the time when patients were admitted into Hospice as the starting point of observation, and detailed records were made of the survival and therapy, the entire study were ended in December 2008. The data collected were filtered and then analyzed by SPSS13.0 software: Using statistics for the description of the data, using t test or test for descriptive analysis, and switching to rank sum test when encountered variance arrhythmia; Using the Kaplan-Meier method and Cox proportional hazard model for univariate and multivariate survival analysis, and comparing of survival curves by Log rank test; Using the repeated measures analysis of variance to evaluate the effects of opioids on quality of lives by making a comparison before and after treatment.【Results】:1. Eventually 361 cases of patients were incorporated into the analysis, the median survival time was 45 days (95% CI: 39 days～51 days). The Cox univariate analysis showed that gender, past relevant histories, past histories of treatments of cancer, primary diagnoses, tumor stages, metastases, pain characters, the pain degrees before treatment, KPS scores before treatment and QOL scores before treatment were associated with the prognoses of patients, which affected the survival times of patients independently (p<0.05); The multivariate survival analysis showed that 5 factors existed statistical significance (p<0.05), and were selected into the Cox model, including gender, primary diagnoses, tumor stages, KPS scores before treatment and QOL scores before treatment.2. The total effective analgesic rate of opioids for the treatment of advanced moderate to severe cancer pain was 90.5% (162/179), including 3 cases of complete remission (1.7%), 77 cases of apparent remission (43.0%), 82 cases of moderate remission (45.8%); Using Kaplan-Meier method to compare the differences between different dose-groups and time-groups of morphine respectively, the results of comparison by Log rank test showed that there were no statistically significant differences between different dose-groups, and different working time-groups of morphine as well (p>0.05), but there was a statistical significance between different duration time-groups of morphine (p<0.05), and the longer duration of pains relieved, the longer survival time.3. After using Opioids, the quality of patients'lives was great improved. The common side effects were constipation, nausea and vomiting, urinary retention and so on, but these symptoms could be reduced or alleviated through appropriate symptomatic treatment. No severe adverse events had been observed in the trial, such as psychological dependence, drug abuse and respiratory depression.【Conclusions】:The rational use of opioids for advanced cancer patients who suffered from moderate to severe pains can alleviate the pains of patients effectively, improve their quality of lives obviously, and not shorten the survival time of them.