Avaliação da Dor em Pacientes Pediátricos com Câncer Ósseo Primário em uma Coorte de um Centro Único

Autores

DOI:

https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3299

Palavras-chave:

sarcoma de Ewing, osteossarcoma, manejo da dor, morte, neoplasias ósseas

Resumo

Introdução: A dor é o principal sintoma descrito em pacientes com câncer. Objetivo: Avaliar a classificação e o manejo da dor em pacientes pediátricos com câncer ósseo primário ao longo do tempo: admissão, durante o tratamento e acompanhamento, e investigar fatores associados à classificação da dor na última avaliação. Método: Estudo de coorte retrospectivo de casos de osteossarcoma e sarcoma de Ewing em indivíduos <19 anos, atendidos em único centro de referência de câncer e acompanhados por equipe multidisciplinar. Desfecho primário: classificação da dor na última avaliação. Desfecho secundário: evolução do tratamento farmacológico. Resultados: Foram incluídos 142 pacientes. A frequência de avaliação da dor aumentou durante o período do estudo de 53,5% na admissão para 68,3% durante o tratamento, chegando a 85,9% no acompanhamento. Dos pacientes cuja dor foi avaliada, 65,8% tiveram dor no recrutamento e 26,2% ao final do estudo. Houve aumento no uso de opioides fortes e antidepressivos. Na última avaliação, 56 pacientes (39,4%) estavam no fim da vida sem associação com mais dor (p=0,68), enquanto os que apresentaram mais dor foram aqueles que usavam opioides fortes (p=0,01) ou esteroides (p=0,03). Conclusão: O manejo da dor durante o tratamento resultou em aumento do uso de opioides fortes e antidepressivos com redução da dor, revelando que o controle da dor é possível. Na última avaliação, os pacientes em fim de vida não apresentavam mais dor, e os pacientes com dor foram os que mais utilizaram opioides fortes e esteroides, evidenciando a dificuldade no controle da dor em alguns pacientes.

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Referências

Instituto Nacional de Câncer. Estimativa 2023: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2022 [acesso 2023 fev 14]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2023.pdf

Portenoy RK, Lesage P. Management of cancer pain. Lancet. 1999;353(9165):1695-700. doi: https://doi.org/10.1016/S0140-6736(99)01310-0 DOI: https://doi.org/10.1016/S0140-6736(99)01310-0

van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, et al. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage. 2016;51(6):1070-1090.e9. doi: https://doi.org/10.1016/j.jpainsymman.2015.12.340 DOI: https://doi.org/10.1016/j.jpainsymman.2015.12.340

Wiffen PJ, Wee B, Derry S, et al. Opioids for cancer pain - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;7(2):CD012592. doi: https://doi.org/10.1002/14651858.CD012592.pub2 DOI: https://doi.org/10.1002/14651858.CD012592.pub2

Mikan F, Wada M, Yamada M, et al. The association between pain and quality of life for patients with cancer in an outpatient clinic, an inpatient oncology ward, and inpatient palliative care units. Am J Hosp Palliat Care. 2016;33(8):782-90. doi: https://doi.org/10.1177/1049909116630266 DOI: https://doi.org/10.1177/1049909116630266

Marec-Bérard P, Delafosse C, Foussat C. Douleurs et tumeurs osseuses malignes de l'enfant et de l'adolescentCancer-related bone pain in children. Arch Pediatr. 2005;12(2):191-8. doi: https://doi.org/10.1016/j.arcped.2004.11.026 DOI: https://doi.org/10.1016/j.arcped.2004.11.026

Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. IASP task force on cancer pain. International Association for the study of pain. Pain. 1999;82(3):263-74. doi: https://doi.org/10.1016/S0304-3959(99)00073-1 DOI: https://doi.org/10.1016/S0304-3959(99)00073-1

Widhe B, Widhe T. Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma. J Bone Joint Surg Am. 2000;82(5):667-74. doi: https://doi.org/10.2106/00004623-200005000-00007 DOI: https://doi.org/10.2106/00004623-200005000-00007

Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. In: Jaffe N, Bruland OS, Bielack S, editors. Pediatric and adolescent osteosarcoma. Boston (MA): Springer; 2009. p. 3-13. doi: http://link.springer.com/10.1007/978-1-4419-0284-9_1 DOI: https://doi.org/10.1007/978-1-4419-0284-9_1

Zernikow B, Szybalski K, Hübner-Möhler B, et al. Specialized pediatric palliative care services for children dying from cancer: a repeated cohort study on the developments of symptom management and quality of care over a 10-year period. Palliat Med. 2019;33(3):381-91. doi: https://doi.org/10.1177/0269216318818022 DOI: https://doi.org/10.1177/0269216318818022

Madden K, Magno Charone M, Mills S, et al. Systematic symptom reporting by pediatric palliative care patients with cancer: a preliminary report. J Palliat Med. 2019;22(8):894-901. doi: https://doi.org/10.1089/jpm.2018.0545 DOI: https://doi.org/10.1089/jpm.2018.0545

Deandrea S, Montanari M, Moja L, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008;19(12):1985-91. doi: https://doi.org/10.1093/annonc/mdn419 DOI: https://doi.org/10.1093/annonc/mdn419

Maltoni M. Opioids, pain, and fear. Ann Oncol. 2008;19(1):5-7. doi: https://doi.org/10.1093/annonc/mdm555 DOI: https://doi.org/10.1093/annonc/mdm555

Senerchia AA, Macedo CR, Ferman S, et al. Results of a randomized, prospective clinical trial evaluating metronomic chemotherapy in nonmetastatic patients with high-grade, operable osteosarcomas of the extremities: a report from the Latin American Group of Osteosarcoma Treatment. Cancer. 2017;123(6):1003-10. doi: https://doi.org/10.1002/cncr.30411 DOI: https://doi.org/10.1002/cncr.30411

Becker RG, Gregianin LJ, Galia CR, et al. What is the impact of local control in Ewing sarcoma: analysis of the first Brazilian collaborative study group - EWING1. BMC Cancer. 2017;17(1):420. doi: https://doi.org/10.1186/s12885-017-3391-5 DOI: https://doi.org/10.1186/s12885-017-3391-5

Snaman JM, Baker JN, Ehrentraut JH, et al. Pediatric oncology: managing pain at the end of life. Pediatr Drugs. 2016;18(3):161-80. doi: https://doi.org/10.1007/s40272-016-0168-2 DOI: https://doi.org/10.1007/s40272-016-0168-2

Chi NC, Demiris G. Family caregivers’ pain management in end-of-life care: a systematic review. Am J Hosp Palliat Care. 2017;34(5):470-85. doi: https://doi.org/10.1177/1049909116637359 DOI: https://doi.org/10.1177/1049909116637359

Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14(1):9-17.

Anghelescu DL, Snaman JM, Trujillo L, et al. Patient-controlled analgesia at the end of life at a pediatric oncology institution. Pediatr Blood Cancer. 2015;62(7):1237-44. doi: https://doi.org/10.1002/pbc.25493 DOI: https://doi.org/10.1002/pbc.25493

Reinfjell T, Zeltzer L. A systematic review of self-reported pain in childhood cancer survivors. Acta Paediatr. 2020;109(1):56-70. doi: https://doi.org/10.1111/apa.14977 DOI: https://doi.org/10.1111/apa.14977

WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: World Health Organization; 2012.

Friedrichsdorf SJ. Pain management in children with advanced cancer and during end-of-life care. Pediatr Hematol Oncol. 2010;27(4):257-61. doi: https://doi.org/10.3109/08880011003663416 DOI: https://doi.org/10.3109/08880011003663416

Fernández Urtubia B, Trevigno Bravo A, Rodríguez Zamora N, et al. Uso de opiáceos en niños con cáncer avanzado en cuidados paliativos. Rev Chil Pediatr. 2016;87(2):96-101. doi: https://doi.org/10.1016/j.rchipe.2015.10.006 DOI: https://doi.org/10.1016/j.rchipe.2015.10.006

Edmonds KP, Saunders IM, Willeford A, et al. Emerging challenges to the safe and effective use of methadone for cancer-related pain in paediatric and adult patient populations. Drugs. 2020;80(2):115-30. doi: https://doi.org/10.1007/s40265-019-01234-6 DOI: https://doi.org/10.1007/s40265-019-01234-6

Anghelescu DL, Tesney JM. Neuropathic pain in pediatric oncology: a clinical decision algorithm. Pediatr Drugs. 2019;21(2):59-70. doi: https://doi.org/10.1007/s40272-018-00324-4 DOI: https://doi.org/10.1007/s40272-018-00324-4

Brown ML, Rojas E, Gouda S. A mind-body approach to pediatric pain management. Children (Basel). 2017;4(6):50. doi: https://doi.org/10.3390/children4060050 DOI: https://doi.org/10.3390/children4060050

Wolfe J, Grier HE, Klar N, et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med. 2000;342(5):326-33. doi: https://doi.org/10.1056/NEJM200002033420506 DOI: https://doi.org/10.1056/NEJM200002033420506

Lykke C, Ekholm O, Olsen M, et al. Paediatric end-of-life care - symptoms and problems: parent assessment. BMJ Support Palliat Care. 2021;bmjspcare-2021-002891. doi: https://doi.org/10.1136/bmjspcare-2021-002891 DOI: https://doi.org/10.1136/bmjspcare-2021-002891

Pritchard M, Burghen EA, Gattuso JS, et al. Factors that distinguish symptoms of most concern to parents from other symptoms of dying children. J Pain Symptom Manage. 2010;39(4):627-36. doi: https://doi.org/10.1016/j.jpainsymman.2009.08.012 DOI: https://doi.org/10.1016/j.jpainsymman.2009.08.012

Leeuw TG, Mangiarini L, Lundin R, et al. Gabapentin as add-on to morphine for severe neuropathic or mixed pain in children from age 3 months to 18 years - evaluation of the safety, pharmacokinetics, and efficacy of a new gabapentin liquid formulation: study protocol for a randomized controlled trial. Trials. 2019;20(1):49. doi: https://doi.org/10.1186/s13063-018-3169-3 DOI: https://doi.org/10.1186/s13063-019-3519-9

Publicado

2023-02-24

Como Citar

1.
Andrade FF de, Valete COS, Ferman S, Silva ARA. Avaliação da Dor em Pacientes Pediátricos com Câncer Ósseo Primário em uma Coorte de um Centro Único. Rev. Bras. Cancerol. [Internet]. 24º de fevereiro de 2023 [citado 25º de novembro de 2024];69(1):e-193299. Disponível em: https://rbc.inca.gov.br/index.php/revista/article/view/3299

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