Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study
Year: 2023
Type: article
Abstract: Background: Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. Methods: This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. Results: A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). Conclusions: In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.
Source: Cancers
Authors: Costanza Donati, Chiara Maggiore, Marco Maltoni, Romina Rossi, Elena Nardi, Alice Zamagni, Giambattista Siepe, Filippo Mammini, Francesco Cellini, Alessia Di Rito, Maurizio Portaluri, Cristina De Tommaso, Anna Santacaterina, Consuelo Tamburella, Rossella Di Franco, Salvatore Parisi, Sabrina Cossa, Vincenzo Fusco, Antonella Bianculli, Pierpaolo Ziccarelli, Luigi Ziccarelli, Domenico Genovesi, Luciana Caravatta, Francesco Deodato, Gabriella Macchia, Francesco Fiorica, Giuseppe Napoli, Milly Buwenge, Alessio Morganti
Institutions: IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Azienda Unità Sanitaria Locale Della Romagna, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto Tumori Bari, Ospedale A. Perrino, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Casa Sollievo della Sofferenza, Centro di Riferimento Oncologico della Basilicata, University of Chieti-Pescara, Azienda Ospedaliera Universitaria Integrata Verona
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,892
OpenAlex ID: W4390196597