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.
背景：疼痛是癌症患者的常见症状，其管理对改善患者生活质量至关重要。然而，转诊至放射治疗科的癌症患者疼痛管理常存在不足，且针对该特定人群的研究有限。本研究旨在评估患者转诊接受放疗时疼痛管理的充分性与有效性，并探讨充分疼痛管理的潜在预测因素。 方法：这项观察性、前瞻性、多中心队列研究纳入18岁及以上转诊至放疗科的癌症患者。采用疼痛管理指数评估疼痛管理情况，该指数通过镇痛药物评分减去疼痛评分计算得出（PMI<0提示疼痛管理不充分）。通过单因素及多因素分析确定充分疼痛管理的预测因素。 结果：研究共纳入1042例门诊癌症患者。分析显示，根据PMI值，42.9%存在疼痛的患者未获得充分疼痛管理。在转诊接受姑息性或根治性放疗的疼痛患者或服用镇痛药患者中，分别有72%和75%存在镇痛治疗不充分或无效的情况。接受姑息性放疗（OR 2.52；p<0.001）、ECOG-PS评分较差（2、3、4分相较于1分的OR值分别为1.63、2.23、5.31；p值分别为0.017、0.002、0.009）的患者获得充分疼痛管理（PMI≥0）的概率更高，而癌性疼痛患者（OR 0.38；p<0.001）及在意大利中南部治疗（相较于北部治疗的OR值分别为0.25、0.42；p<0.001）的患者概率较低。 结论：本研究发现转诊至放疗科的癌症患者中有相当比例未获得充分疼痛管理。需通过教育及组织策略改善该人群疼痛管理不足的现状。此外，加强对非癌性疼痛的关注以及在疾病进程中更早转诊患者接受姑息性放疗，可能提升疼痛缓解效果并改善治疗结局。
肿瘤(癌症)患者之家