Correlates of increased narcotic use during pain-mediated 3F8 monoclonal antibody therapy in children diagnosed with high-risk neuroblastoma.

摘要

Introduction: Pain was described as a physical, psychological, and emotional experience. Pain was always subjective and each person learned the meaning of the word through experiences related to injury in early life.;For children diagnosed with cancer, pain from procedures had been consistently reported as the main source of pain. This was also true for children diagnosed with high-risk neuroblastoma, especially during anti-GD2 monoclonal antibody therapy.;Study Purpose: The purpose of this study was to identify variables correlating with increased pain, as measured by the number of narcotic doses used during 3F8 monoclonal antibody treatment. Other aims of this study were to describe side effects of 3F8, to describe the effects of anxiolytics and antihistamines on narcotic use during antibody treatment, and to generate new hypotheses for future research.;Methods: Research design implemented for this study was a retrospective analysis. Pertinent patient information was extracted through a systematic chart review. Study sample consisted of 54 high-risk neuroblastoma patients treated at Memorial Sloan- Kettering Cancer Center, and were enrolled in 3F8 monoclonal antibody protocols 9418 and 03-077.;Research measures for this study consisted of clinical, psychosocial, and demographical variables. Pain was measured by the number of narcotic "recues" patients received during treatment. Each rescue dose was calculated according to patient's weight in kilograms.;Data analysis was initially performed using frequency tables and graphs to determine central tendencies and dispersion of the narcotic data. Then, box plots were used to graph patients' narcotic requirements grouped by categorical and non-parametric variables. Lastly, other correlations of increased pain were determined by scatter plots, by calculating the Pearson product-moment coefficient, by using multiple regression models, and by analysis of variance.;Results: Results showed that patients on 9418 experienced more pain than those on 03-077. Also, patients received more narcotic rescues during cycle 1 on both protocols. Box plots revealed that secondary refractory patients experienced more pain than patients in complete remission, primary refractory, or secondary remission. When grouped by religion, patients coded as Greek Orthodox and the ones coded not having a religion had the highest median narcotic scores. By primary residence, non-United States residents scored the highest median scores, followed by patients residing in other states; and patients from the tri-state area required the least amount of narcotics. Results also showed that non- English speaking patients and patients who were not covered by American insurance had more pain during 3F8. Lastly, patient age, and the use of anxiolytics and antihistamines during antibody treatments also correlated with increased pain.