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Donati CM, Galietta E, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Mammini F, Di Franco R, Parisi S, Cossa S, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Cammelli S, Cavallini L, Buwenge M, Rossi R, Maltoni M, Morganti AG, Cilla S. Further Clarification of Pain Management Complexity in Radiotherapy: Insights from Modern Statistical Approaches. Cancers (Basel) 2024; 16:1407. [PMID: 38611085 PMCID: PMC11010980 DOI: 10.3390/cancers16071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The primary objective of this study was to assess the adequacy of analgesic care in radiotherapy (RT) patients, with a secondary objective to identify predictive variables associated with pain management adequacy using a modern statistical approach, integrating the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and the Classification and Regression Tree (CART) analysis. METHODS This observational, multicenter cohort study involved 1387 patients reporting pain or taking analgesic drugs from 13 RT departments in Italy. The Pain Management Index (PMI) served as the measure for pain control adequacy, with a PMI score < 0 indicating suboptimal management. Patient demographics, clinical status, and treatment-related factors were examined to discern the predictors of pain management adequacy. RESULTS Among the analyzed cohort, 46.1% reported inadequately managed pain. Non-cancer pain origin, breast cancer diagnosis, higher ECOG Performance Status scores, younger patient age, early assessment phase, and curative treatment intent emerged as significant determinants of negative PMI from the LASSO analysis. Notably, pain management was observed to improve as RT progressed, with a greater discrepancy between cancer (33.2% with PMI < 0) and non-cancer pain (73.1% with PMI < 0). Breast cancer patients under 70 years of age with non-cancer pain had the highest rate of negative PMI at 86.5%, highlighting a potential deficiency in managing benign pain in younger patients. CONCLUSIONS The study underscores the dynamic nature of pain management during RT, suggesting improvements over the treatment course yet revealing specific challenges in non-cancer pain management, particularly among younger breast cancer patients. The use of advanced statistical techniques for analysis stresses the importance of a multifaceted approach to pain management, one that incorporates both cancer and non-cancer pain considerations to ensure a holistic and improved quality of oncological care.
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Affiliation(s)
- Costanza Maria Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessia Di Rito
- Radiotherapy Unit, IRCCS Istituto Tumori ‘Giovanni Paolo II’ Bari, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fodazione G. Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Antonella Bianculli
- Medical Physics Department, IRCCS-CROB—Centro di Riferimento Oncologico della Basilica, 85028 Rionero in Vulture, Italy
| | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66013 Chieti, Italy
| | - Luciana Caravatta
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Letizia Cavallini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Romina Rossi
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Marco Maltoni
- Medical Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
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