Caracterización del dolor en neoplasias hematológicas avanzadas del adulto en la red pública. Ministerio de Salud de Chile

Abstract

Aim: The purpose of this study is to characterize pain in adults with advanced hematological malignancies at the public health network of Pain Relief and Palliative Care Program in Chile. Method: Retrospective review of the database of active patients attended during 2011. Patients with lymphoma, acute and chronic leukemia and multiple myeloma who met the inclusion criteria were included, including pain intensity through visual analogue scale (VAS) at entry and death and type of pain. ECOG Performance Status Scale (PS) and Edmonton Symptom Assessment Scale (ESAS) for rest symptoms. Results: Out of 24.094 active patients, 771 (3,2 %), had advanced hematological malignancy and 400 (52,0 %) met the inclusion criteria. The most common hematologic neoplasia were leukaemia and multiple myeloma. At admission pain was present in 88,3 % of cases, in multiple myeloma 96,7 % (134/140 cases), leukemia 87,5 % (126/144), non Hodgkin lymphoma 80,4 % (86/107) and Hodgkin lymphoma 77,8 % (7/9). Pain type was associated with diagnosis (p < 0,05). The most common type of pain was mixed 56 %, just somatic 14 %, just neuropathic 13 % and just visceral 5,5 %. And 11,7 % had no pain. According to ECOG at entrance, 33 % were autonomous and 7 % bedridden. Fatigue was the most prevalent symptom besides pain. Mean stay was 112 ± 70 days (range 1-336). VAS felt from 6 to 2 points (p < 0,05) at death. In 96,2 % VAS was equal or less than 4 (p < 0,05) at end of life. Conclusions: Pain was present in 88,3 % of advanced hematological malignancy, 96,7 % in multiple myeloma. Pain type was associated with diagnosis. Mixed pain was the most common and fatigue the most relevant symptom besides pain. Effective pain relief was achieved, lowering EVA from 6 to 2 points prior to death and 96.2 % of patients achieving a final EVA ≤ 4.