Cancers (Apr 2024)

Further Clarification of Pain Management Complexity in Radiotherapy: Insights from Modern Statistical Approaches

  • Costanza Maria Donati,
  • Erika Galietta,
  • Francesco Cellini,
  • Alessia Di Rito,
  • Maurizio Portaluri,
  • Cristina De Tommaso,
  • Anna Santacaterina,
  • Consuelo Tamburella,
  • Filippo Mammini,
  • Rossella Di Franco,
  • Salvatore Parisi,
  • Sabrina Cossa,
  • Antonella Bianculli,
  • Pierpaolo Ziccarelli,
  • Luigi Ziccarelli,
  • Domenico Genovesi,
  • Luciana Caravatta,
  • Francesco Deodato,
  • Gabriella Macchia,
  • Francesco Fiorica,
  • Giuseppe Napoli,
  • Silvia Cammelli,
  • Letizia Cavallini,
  • Milly Buwenge,
  • Romina Rossi,
  • Marco Maltoni,
  • Alessio Giuseppe Morganti,
  • Savino Cilla

DOI
https://doi.org/10.3390/cancers16071407
Journal volume & issue
Vol. 16, no. 7
p. 1407

Abstract

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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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