ABSTRACT
Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment to determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control (P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.
ABSTRACT
Introducción: La calidad de vida es una de las principales preocupaciones de los pacientes con cáncer en cuidados paliativos, sin embargo, los estudios sobre la calidad de vida en estos pacientes son limitados. Objetivo: Determinar los factores asociados a la calidad de vida en pacientes con enfermedad oncológica en cuidados paliativos. Métodos: Estudio observacional, analítico en 184 pacientes oncológicos atendidos en una Unidad de Dolor y Cuidados Paliativos durante el 2021. La variable dependiente fue la calidad de vida; las independientes la edad, sexo, nivel de instrucción, ocupación, diagnóstico oncológico, tiempo y estadio de enfermedad. Se calculó la razón de prevalencias cruda (RP) y ajustada (RPa) con nivel de confianza de 95%. Resultados: La edad mediana fue 63 años, y el 66,3% fueron del sexo femenino. Los factores asociados a la calidad de vida fueron cáncer de mama (RPa=1,21; IC95%: 1,07-1,36; p!<0,010), de próstata (RPa=1,36; IC95%: 1,18-1,56; p!<0,010) o mieloma múltiple (RPa=1,33; IC95%: 1,15-1,53; p!<0,010), en comparación a otros cánceres como linfoma de Hodgkin, cáncer de estómago, renal o de páncreas; el tiempo de enfermedad mayor a 36 meses (RPa=1,13; IC95%: 1,01-1,27; p=0,040) y el estadio III (RPa=1,30; IC95%: 1,19-1,42; p!<0,010) también se asociaron a la calidad de vida. Conclusiones: Los factores asociados a la calidad de vida fueron tener cáncer de mama, de próstata o mieloma múltiple, en comparación con tener otro tipo de cáncer; además de un tiempo de enfermedad mayor a 36 meses y el estadio III frente al estudio I/II.
Introduction: Quality of life is one of the main concerns for cancer patients in palliative care; however, studies on quality of life in these patients are limited. Objective: To determine the factors associated with quality of life in patients with oncological disease in palliative care. Methods: Observational, analytical study in 184 cancer patients treated in a Pain and Palliative Care Unit during 2021. The dependent variable was quality of life; independent variables were age, sex, education level, occupation, oncological diagnosis, disease duration, and stage. Crude (RP) and adjusted (aRP) prevalence ratios were calculated with a 95% confidence level. Results: The median age was 63 years, and 66.3% were female. Factors associated with quality of life were breast cancer (aRP=1.21; 95% CI: 1.07-1.36; p!<0.010), prostate cancer (aRP=1.36; 95% CI: 1.18-1.56; p!<0.010), or multiple myeloma (aRP=1.33; 95% CI: 1.15-1.53; p!<0.010), compared to other cancers such as Hodgkin's lymphoma, stomach, kidney, or pancreatic cancer; disease duration longer than 36 months (aRP=1.13; 95% CI: 1.01-1.27; p=0.040), and stage III (aRP=1.30; 95% CI: 1.19-1.42; p!<0.010) were also associated with quality of life. Conclusions: Factors associated with quality of life were having breast, prostate, or multiple myeloma cancer, compared to having another type of cancer; in addition to a disease duration longer than 36 months and stage III compared to stage I/II.
