Serum Lactate Dehydrogenase Levels May Predict Fentanyl Usage in Patients with Metastatic Cancersfor The Treatment of Cancer Related Pain

Yıl 2016, Cilt: 2 Sayı: 2, 0 - 0, 29.06.2016

Cemil Bilir Mehmet Sabri Balık Bayram Kızılkaya Şafak Yıldırım Sinan Gemez Filiz Bilir

Öz

Giriş: Opioid aşırı kullanımı sağlık sağlayıcıları ve denetleyicilerinin dikkatini çekmeye başlamıştır. Ancak diğer taraftan ise kanser hastalarında
ağrı en sık semptom olmanın yanında ileri evre vakalarda ağrı sıklıkla hayat kalitesinin de düşürmektedir. Bu çalışmada rutin biyokimyasal
parametreler ile opioid dozları arasındaki ilişkiyi aşırı kullanımı önlemek amacıyla araştırdık.
Metod: 75 ileri veya metastatik evrede kanser hastasını takip ettik. Medikal kayıtlar retrospektif olarak incelendi.
Bulgular: 75 hastanın yaş ortalaması 58(34-80) olup 54 erkek ve 21 hasta kadındı. En sık metastaz yeri 40 (%53) hastada kemik iken, 20 (%26)
hastada lenf nodu, 10 (%13) hastada karaciğer, ve 7 (%9) hastada beyin idi. Tüm hastalar Comparative Pain Scale (CPS) skorlaması ile takip
edildi ve ortanca CPS skoru tedavi öncesi 5 (3-9) iken takiplerde anlamlı derecede azalma gösterdi, CPS değeri 2 (0-6), P<0.001. Korelasyon
analizinde tüm biyokimyasal değerler ile analjezikler dozları ile karşılaştırıldı. Serum laktad dehidrogenaz düzeyleri fentanil dozu arasında
anlamlı ilişki bulundu (Pearson correlation was 0.33, P=0.003).
Sonuç: Kanser tiplerinden bağımsız olarak artmış serum LDH düzeyleri fentail dozu ve CPS skoru ile anlamlı olarak ilişkili bulunmuştur.
Anahtar Kelimeler Serum laktad dehidrogenaz, ağrı, opioid, fentanil

Kaynakça

• Rauenzahn S, Del Fabbro E. Opioid management of pain: the impact of the
• prescription opioid abuse epidemic. Curr Opin Support Palliat Care 2014;
• :273-8.
• National Institute on Drug Abuse Research Report Series – prescription
• drugs: abuse and addiction. 2011. Available at http://www.drugabuse.gov/
• sites/default/files/rrprescription.pdf. (Accessed 18 April 2014)
• Vital signs: overdoses of prescription opioid pain relievers – United
• States,1999–2008. MMWR 2011;60;1487-1492.
• Kaasa S, Mercadante S, Caraceni A. Cancer pain--progress and ongoing
• issues in Europe. Pain Res Manag 2009; 14:353-355.
• Daut RL, Cleeland CS, Flanery RC. Development of the Wisconsin Brief
• Pain Questionnaire to assess pain in cancer and other diseases. Pain 1983;
• :197-210.
• Wang XS, Cleeland CS. Outcomes measurement in cancer pain. In: Pain
• Management: Evidence, Outcomes, and Quality of Life. A Sourcebook --
• Wittink HM, Carr DB, eds. London: Elsevier 2008; 361-76.
• Casty F.E, Wieman M.S, Shusterman N. Current Topics in Opioid Therapy
• for Pain Management: Addressing the Problem of Abuse. Clin Drug Investig
• ; 33:459–468.
• US Department of Justice. Promoting pain relief and preventing abuse of
• pain medications: a critical balancing act. 2012. http://www.deadiversion.
• usdoj.gov/pubs/advisories/painrelief.pdf. Accessed 6 Apr 2012.
• Centers for Disease Control and Prevention. Vital signs: overdoses of
• prescription opioid pain relievers—United States, 1999–2008. MMWR
• Wkly. 2011;60(43):1487–92.
• Atzpodien J, Royston P, Wandert T, Reitz M, and German Cooperative
• Renal Carcinoma Chemo-Immunotherapy Trials Group. Metastatic renal
• carcinoma comprehensive prognostic system. Br J Cancer 2003;88:348–53.
• Suh SY, Ahn HY. Lactate dehydrogenase as a prognostic factor for survival
• time of terminally ill cancer patients: a preliminary study. Eur J Cancer
• ;43:1051-9.
• Walenta S, Mueller-Klieser WF. Lactate:Mirror and motor of tumor
• malignancy. Semin Radiat Oncol 2004;14: 267–74.
• Herndon JE, Green MR, Chahinian AP, Corson JM, Suzuki Y, Vogelzang
• NJ. Factors predictive of survival among 337 patients with mesothelioma
• treated between 1984 and 1994 by the cancer and leukemia group B.
• Chest 1998;113:723–31.
• Butt AA, Michaels S, Greer D, Clark R, Kissinger P, Martin DH. Serum LDH
• level as a clue to the diagnosis of histoplasmosis. AIDS Read 2002;12:317–
• Quist J, Hill AR. Serum lactate dehydrogenase (LDH) in Pneumocystis carinii
• pneumonia, tuberculosis, and bacterial pneumonia. Chest 1995;108:415–
• Malbotra P, Sidhu LS, Singh SP. Serum lactate dehydrogenase level in
• various malignancies. Neoplasma 1986;33:641–7.
• Jin Y, Ye X, Shao L, Lin BC, He CX, Zhang BB, Zhang YP. Serum lactic
• dehydrogenase strongly predicts survival in metastatic nasopharyngeal
• carcinoma treated with palliative chemotherapy. Eur J Cancer
• ;49:1619-26.
• Cook RJ, Coleman R, Brown J, Lipton A, Major P, Hei YJ, et al. Markers of
• bone metabolism and survival in men with hormone-refractory metastatic
• prostate cancer. Clin Cancer Res 2006;12:3361–7.
• Brown JE, Cook RJ, Lipton A, Coleman RE. Serum lactate dehydrogenase is
• prognostic for survival in patients with bone metastases from breast cancer:
• a retrospective analysis in bisphosphonate-treated patients. Clin Cancer Res
• ; 15;18:6348-55.