Drug therapy for anxiety in adult palliative care patients

 

Abstract

Background

Anxiety is common among patients with advanced disease. It can be a natural response to impending death, but may also result from an underlying anxiety disorder, pain, or other untreated or poorly managed symptoms.

Objectives

The primary objective of this review was to identify and evaluate studies examining medications used to treat patients suffering from anxiety during the terminal phases of disease.

Search methods

We searched the following sources: MEDLINE (1966 to July 2003), EMBASE (1980 to July 2003) , CINAHL (1982 to July 2003), PsycLit (1974 to July 2003), PsycInfo (1990 to July 2003), and The Cochrane Library (Issue 2, 2003) for literature pertaining to this topic published in any language using a detailed search strategy.

Selection criteria

Prospective, randomized trials with or without blinding involving the use of pharmacological agents for the treatment of anxiety at the end of life were sought.

Data collection and analysis

Six potential studies were identified by the search strategy but none met the criteria for inclusion in this review. Two of these studies assessed the effectiveness of alprazolam in patients with a diagnosis of cancer, but who would not be considered in the end-stage of life.

Main results

No data were available to enable an assessment to be made of the effectiveness of drugs to treat anxiety in palliative care patients.

Authors' conclusions

There remains insufficient evidence to draw a conclusion about the effectiveness of pharmacotherapy for anxiety in terminally ill patients. To date no studies were found that met the inclusion criteria for this review. Prospective controlled clinical trials are necessary in order to establish the benefits and harms of pharmacotherapy for the treatment of anxiety in palliative care.

 

Plain language summary

Drug therapy for anxiety in palliative care

Currently there is no evidence on the role of drugs in the treatment of anxiety associated with terminal illness. Anxiety is a common symptom associated with patients near the end of life. As with other areas of palliative care, the majority of available literature pertaining to drug therapy for anxiety in terminal illness is anecdotal. A search of the international literature for randomised clinical trials in the area of drug therapy for anxiety in palliative care yielded no results. As a consequence, it is not possible to assess the effectiveness of treatment options. It is hoped that this review will motivate future research into this area.

 

摘要

背景

焦慮於安寧照護之藥物治療

焦慮常見於疾病末期的病人。這可能是出自對逼近的死亡之自然反應，但也可能是潛在的焦慮疾病、疼痛或是其他未獲治療或治療效果不彰的症狀所導致。

目標

此回顧的主要目標是確認並評估在疾病末期用來治療罹患焦慮病人的藥物之研究。

搜尋策略

我們使用了一個詳盡的搜尋策略，透過MEDLINE (1966 年到2003年七月)，EMBASE (1980年到2003年七月) ， CINAHL (1982年到2003年七月)， PsycLit (1974年到2003年七月)， PsycInfo (1990年到2003年七月)，以及the Cochrane Library (Issue 2, 2003)等資料來源搜尋以任何語言所發表與此主題相關的文獻。

選擇標準

無論有無使用盲性設計，只要是前瞻性隨機試驗，且病人生命末期有使用藥物治療焦慮者皆在搜尋的範圍。

資料收集與分析

透過此搜尋策略一共找出6個可能的研究，但是沒有任何一個研究符合本回顧的標準。其中2個研究評估alprazolam在診斷為癌症之病人的療效，但這些病人並非在生命末期。

主要結論

沒有數據可用來評估接受安寧照護的病人在治療焦慮時的藥物療效。

作者結論

迄今仍沒有足夠證據能對於在疾病末期、且罹患焦慮的病人在藥物治療焦慮上做出結論。至今並未發現符合本回顧選擇標準的研究。要知道在安寧照護下病人接受藥物以治療焦慮的好壞處，需要前瞻性對照之臨床試驗。

翻譯人

本摘要由三軍總醫院洪乃勻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前並無證據能確認藥物在治療疾病末期相關焦慮的角色。焦慮是接近生命終點的病人常有的症狀。如同安寧照護的其他領域，大多數現有關於疾病末期焦慮的藥物治療只有零星的報告。搜尋在安寧照護下治療焦慮藥物之隨機臨床試驗的國際文獻並無任何結果。因此無法評估其療效。希望此一回顧將促使未來在這個領域有更進一步的研究。